ECMO Mortality Remains High
A nationwide cohort study found high in-hospital mortality among adults receiving extracorporeal membrane oxygenation (ECMO), with risk shaped by age and comorbidity.
In a retrospective analysis of nationwide hospitalization data, investigators evaluated 15,151 adults who received extracorporeal membrane oxygenation between 2011 and 2020. Overall, 9,657 patients died during hospitalization, corresponding to an in-hospital mortality rate of 63.7%. The findings highlight the substantial mortality burden associated with ECMO in routine adult care and offer a population-level view of which factors may influence outcomes.
Patient and Treatment Factors Linked to ECMO Mortality
The analysis showed that several factors were associated with higher odds of in-hospital mortality among adults receiving extracorporeal membrane oxygenation. Older age was linked to greater mortality risk, as was a higher comorbidity burden, defined as a Charlson Comorbidity Index of three or more. Use of multiple ECMO machines, specifically two or more, was also associated with higher adjusted odds of death during hospitalization.
The authors suggested that these findings may reflect both underlying patient complexity and greater ECMO treatment intensity. In contrast, longer hospital length of stay was inversely associated with in-hospital mortality, which the investigators interpreted as likely reflecting different care trajectories among ECMO recipients rather than a simple protective effect.
Diagnosis Classification May Help Refine Risk Assessment
The study also examined diagnosis-based ECMO indication groups using ICD coding and categorized patients into four mutually exclusive clinical groups. Compared with patients who did not have cardiopulmonary indications, those classified as having cardiogenic shock alone or combined respiratory failure and cardiogenic shock had lower adjusted odds of in-hospital mortality.
These results suggest that diagnosis-based indication classification may help identify meaningful differences in ECMO outcomes across adult patient groups. The investigators concluded that in-hospital mortality among ECMO recipients remains high and is associated with age, comorbidity burden, treatment complexity, and indication classification. They noted that these real-world findings may support risk communication with patients and families, while also informing system-level planning for ECMO care.
Reference
Tsai HE et al. Factors Associated with In-Hospital Mortality Among Adults Receiving ECMO: A Nationwide Cohort Study (2011-2020). J Clin Med. 2026;15(5):1770.
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