Outcomes and survival prediction in adults with sickle cell disease treated with extracorporeal membrane oxygenation

The utility of extracorporeal membrane oxygenation (ECMO) support for adult patients with sickle cell disease (SCD) remains poorly understood. We aimed to characterize a cohort of adult individuals with SCD in the Extracorporeal Life Support Organization (ELSO) registry who underwent venoarterial (VA) or venovenous (VV) ECMO treatment, assess clinical outcomes, and determine predictors of mortality. This multicenter, retrospective study evaluated in-hospital mortality and clinical outcomes such as bleeding and thrombotic events (BTEs) of adult patients in the ELSO registry with SCD-associated International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes. Post hoc multivariable logistic regression model was developed assessing predictors of mortality. Of 206 included patients, 126 and 80 received cannulation for VA ECMO or VV ECMO, respectively. Eighty-three patients (40.3%) were discharged alive; in-hospital survival was 25.5% and 61.1% for VA and VV ECMO, respectively (P < .001). BTEs were common during VA (45.6%) and VV (33.8%) ECMO support. There was significant increase in BTE incidence for nonsurvivors compared with survivors with VA ECMO (55.4% vs 26.5%; P < .001) and VV ECMO (58.1% vs 18.4%; P = .01). Male sex, increased age, pre-extracorporeal life support (ECLS) cardiac arrest, cannulation for extracorporeal cardiopulmonary resuscitation (eCPR), and elevated lactate were predictive of in-hospital mortality in the VA ECMO cohort. In conclusion, in adult patients with SCD, in-hospital survival was significantly lower with VA ECMO than VV ECMO. Male sex, increased age, eCPR support, elevated lactate, and pre-ECLS arrest were strongest indicators of VA ECMO mortality. Bleeding and thrombotic complications have an association with inpatient mortality for those treated with ECMO.