Factors Associated with In-Hospital Mortality Among Adults Receiving ECMO: A Nationwide Cohort Study (2011–2020)

TL;DR

This study finds that older age, more health problems, and complex ECMO treatments are linked to higher death rates in adult patients receiving ECMO in hospitals.

Contribution

The study provides nationwide real-world evidence on factors influencing mortality in adult ECMO patients using a large-scale database in Taiwan.

Findings

63.7% of 15,151 adult ECMO patients died during hospitalization.

Older age, higher comorbidity burden, and use of multiple ECMO machines were associated with higher mortality.

Patients with cardiogenic shock had lower adjusted odds of mortality compared to others.

Abstract

Background/Objectives: Extracorporeal membrane oxygenation (ECMO) use has increased worldwide, yet in-hospital mortality among adult recipients remains substantial. Large-scale evidence examining patient- and treatment-related factors associated with mortality in real-world settings is still limited. This study aimed to quantify in-hospital mortality and identify factors associated with mortality among adults receiving ECMO using a nationwide cohort in Taiwan. Methods: We conducted a retrospective nationwide cohort study using Taiwan’s National Health Insurance Research Database, including adults (≥18 years) who received ECMO during hospitalization between 2011 and 2020. ECMO indication groups were defined using ICD-9-CM (before 2016) and ICD-10-CM (2016 onward) codes and further classified into four mutually exclusive categories. Multivariable logistic regression was used to examine factors associated with in-hospital mortality. Results: Among 15,151 adults treated with ECMO, 9657 (63.7%) died during hospitalization. In multivariable analyses, higher odds of in-hospital mortality were associated with older age, higher comorbidity burden (Charlson Comorbidity Index ≥3), and use of multiple ECMO machines (≥2). Compared with patients without cardiopulmonary indications, those classified as cardiogenic shock alone or combined respiratory failure and cardiogenic shock had lower adjusted odds of in-hospital mortality. Longer hospital length of stay was inversely associated with in-hospital mortality, reflecting differing care trajectories among ECMO recipients. Conclusions: In this nationwide real-world cohort of adult ECMO recipients, in-hospital mortality was high, and mortality risk was associated with patient age, comorbidity burden, ECMO treatment complexity, and diagnosis-based indication classification. These findings provide population-level insight into mortality patterns and may inform risk communication and system-level planning for ECMO care.