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Extracorporeal Membrane Oxygenation Discontinuation Due to Resource Limitations
Rodrigo Cardoso Cavalcante1, Marissa Brunetti2, Jo-Ching Hsiung3
1From the Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|January 9, 2026
Summary
Extracorporeal membrane oxygenation discontinuation due to resource limitation (EDRL) is rare but increasing globally, especially post-COVID-19. Rates vary by region, with lower survival in Latin America and Southwest Asia/Africa.
Area of Science:
- Critical Care Medicine
- Global Health
- Health Systems Research
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support technology used for severe cardiorespiratory failure.
- Resource limitations can necessitate ECMO discontinuation, a rare but critical event.
- Understanding the epidemiology of ECMO discontinuation due to resource limitation (EDRL) is vital for global health equity.
Purpose of the Study:
- To analyze the global incidence and trends of EDRL.
- To compare EDRL rates across different geographic regions.
- To assess changes in EDRL before and after the COVID-19 pandemic.
Main Methods:
- Retrospective cohort analysis of international ECMO center data from 2013-2023.
- Inclusion of all pediatric and adult ECMO runs.
- Analysis of EDRL events, diagnoses, survival, and regional variations.
Main Results:
- 312 (0.19%) of 161,851 ECMO runs resulted in EDRL.
- EDRL increased significantly post-COVID-19 (1.44 to 2.44 per 1,000 runs).
- Europe and North America showed disproportionate increases; Latin America and Southwest Asia/Africa had high EDRL proportions and low survival.
Conclusions:
- EDRL is a rare but growing concern in ECMO care.
- Significant regional disparities exist in EDRL rates and outcomes.
- The COVID-19 pandemic exacerbated EDRL, highlighting resource allocation challenges in critical care.
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