Mode of death after venovenous extracorporeal membrane oxygenation - a retrospective single-center analysis

Mortality of patients supported with veno-venous extracorporeal membrane oxygenation (VV ECMO) is high. Selection of patients likely to survive is challenging as reliable predictive scoring systems are lacking. For a better understanding of preconditions and complications associated with unfavorable outcome we assessed reasons for death in patients who did not survive ECMO support or who died in-hospital after weaning from ECMO. In this single-center retrospective observational trial all patients supported with VV ECMO at the University of Freiburg Medical Center's Department for Interdisciplinary Medical Intensive Care between February 2009 and July 2021 were included. 206/374 patients (55 %) died after initiation of ECMO. Causes of death were respiratory failure (101/206, 49.0 %), cardiocirculatory failure (49/206, 23.8 %), treatment withdrawal due to limited neurological prognosis (30/206, 14.6 %), or due to severe comorbidities (23/206, 11.2 %). Fatal ECMO device complications were rare. Major predictors for mortality were pulmonary fibrosis, liver disease and immunosuppression. Half of the deaths were due to non-respiratory causes. This observation may inform future trials assessing selection criteria for VV ECMO, treatment associated complications and complication management and the meaning and relevance of extra-pulmonary preconditions.