Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home Points

Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home Points

Background: Mortality for patients who are critically ill receiving extracorporeal membrane oxygenation (ECMO) support (venovenous or venoarterial) is high, but the proximal causes of death have not been characterized fully. Research Question: We aimed to characterize the reasons for death in patien...

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Main Authors: Renata P. Lerner, MD, PhD, Amira Mohamed, MD, Annette Ilg, MD, Raghu R. Seethala, MD, Alison Witkin, MD, Jerome Crowley, MD, Anthony Carlese, MD, Michelle Ng Gong, MD, MPH, Iris Aimlin, MD, Jen-Ting Chen, MD, MS, David Furfaro, MD, MPH, Brian O’Gara, MD, Ryan Gardner, MD, Malorie Butera, RN, Shahzad Shaefi, MD, MPH, Daniel Knox, MD, Daniel Gutteridge, MD, MBA, Christie Horner, BSN, CCRN, Anthony Manasia, MD, MPH, Nidhi Kavi, MD, Marjan Rahmanian, MD, Ari Moskowitz, MD, MPH
Format: Article
Language:English
Published: Elsevier 2025-03-01
Series:CHEST Critical Care
Subjects:
ECMO
mortality
palliative care
venoarterial
venovenous
Online Access:http://www.sciencedirect.com/science/article/pii/S2949788424000686
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Summary:Background: Mortality for patients who are critically ill receiving extracorporeal membrane oxygenation (ECMO) support (venovenous or venoarterial) is high, but the proximal causes of death have not been characterized fully. Research Question: We aimed to characterize the reasons for death in patients who underwent cannulation while receiving venoarterial or venovenous ECMO. Study Design and Methods: This was a retrospective multicenter observational cohort study of adult patients who underwent cannulation for ECMO and who died while receiving ECMO at 6 medical centers in the United States. Results: We categorized the causes of death for 751 patients who underwent cannulation for ECMO. We summarized and compared baseline patient characteristics among the 6 sites. Reasons for death were comorbid withdrawal of life-sustaining therapy (n = 248 [33%]), progressive hemodynamic shock (n = 200 [27%]), neurologic withdrawal of life-sustaining therapy (n = 135 [18%]), cardiogenic shock (n = 126 [17%]), respiratory failure (n = 31 [4.1%]), and equipment failure (n = 11 [1.5%]). Comorbid withdrawal of life-sustaining therapy was the most common cause of death in patients who underwent cannulation for both venoarterial (n = 141 [29%]) and venovenous (n = 107 [41%]) ECMO. The rate of palliative care consultation differed among sites. Interpretation: This study showed that most deaths result from comorbid withdrawal of life-sustaining therapy and that death or withdrawal because of refractory respiratory failure and cardiogenic shock account for a lower proportion of deaths in patients receiving ECMO. Our efforts to reduce mortality in patients receiving ECMO should account for the proportion of deaths attributable to comorbid withdrawal of life-sustaining therapy.
ISSN:2949-7884

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