Extracorporeal Membrane Oxygenation Discontinuation Due to Resource Limitations

To examine the global epidemiology of extracorporeal membrane oxygenation discontinuation due to resource limitation (EDRL), assessing differences across geographic regions and between pre- and post-coronavirus disease 2019 (COVID-19) periods. Retrospective cohort analysis of all children and adults from international ECMO centers (2013-2023) in which ECMO was discontinued due to resource limitations. Of the 161,851 ECMO runs, 312 (0.19%) underwent EDRL. Of those, 25% occurred in children. Leading diagnoses were cardiogenic shock (n = 62, 20%) and COVID-19 (n = 33, 11%). Twelve percent survived post-EDRL and 29% were transported on ECMO for resource reallocation. Extracorporeal membrane oxygenation discontinuation due to resource limitations increased worldwide over time, particularly following COVID-19 (1.44 EDRLs per 1,000 ECMO runs vs. 2.44 EDRLs per 1,000 ECMO runs, p < 0.001), disproportionately to the overall increase in ECMO utilization ( p = 0.019), especially in Europe ( p < 0.001) and North America ( p = 0.003). Latin America and Southwest Asia/Africa exhibited high proportions of EDRLs relative to ECMO runs (12.8 and 4.8 per 1,000 cannulations, respectively) and low post-EDRL survival rates (6.7% and 0%, respectively). Resource limitation remains a rare indication for ECMO decannulation, differs across global regions, and has grown over time disproportionately to the overall increase in ECMO use, particularly in Europe and North America and with the onset of the COVID-19 pandemic.