Outcomes of extracorporeal membrane oxygenation in immunocompromised patients: a national cohort analysis, 2018-2022

The use of extracorporeal membrane oxygenation (ECMO) in immunocompromised patients remains controversial, with unclear mortality risk.

We assessed the impact of immunosuppression on ECMO outcomes using the National Inpatient Sample (NIS).

We performed a retrospective analysis of the 2018-2022 NIS, identifying hospitalizations of patients >15 years requiring ECMO using ICD-10-PCS codes. Patients were stratified by immunocompromised status, and the primary outcome was in-hospital mortality. Multivariable logistic regression adjusted for demographics, hospital factors, length of stay, and comorbidities was used to identify mortality predictors, with subgroup analyses by immunocompromised status.

Among 11,218 ECMO hospitalizations, 1154 (10.3%) involved immunocompromised patients. Immunocompromised patients had longer hospital stays (median 33 vs 18 days; p<0.001); however, in-hospital mortality was similar to non-immunocompromised patients (40.6%vs 45.0%; p=0.68), with no difference after adjustment (aOR 1.08, 95% CI 0.92-1.26). In the overall ECMO population, mortality was independently associated with advanced age, Hispanic race, cerebrovascular disease, metastatic cancer, moderate-to-severe liver disease, peripheral vascular disease, peptic ulcer disease, and use of continuous renal replacement therapy (CRRT). Within the immunocompromised cohort, mortality was independently associated with CRRT and cerebrovascular disease.

Immunosuppression was not independently associated with increased in-hospital mortality among patients supported with ECMO. Mortality in this population appears to be driven primarily by comorbid burden and multiorgan dysfunction rather than immunosuppression alone.