25: Prevalence and survival of prolonged venovenous ECMO for ARDS: an analysis of the Extracorporeal Life Support Organization Registry

Rationale: Although prolonged support of patients with ARDS with venovenous extracorporeal membrane oxygenation (VV ECMO) is increasingly common, outcomes of prolonged VV ECMO support remains poorly defined. Objectives: To examine trends in utilization and outcomes among patients with ARDS requiring prolonged VV ECMO support. Methods: Adult patients in the Extracorporeal Life Support Organization (ELSO) registry supported with VV ECMO for ARDS between January 2012 and December 2022 were identified. Mortality while supported with VV ECMO and survival to hospital discharge based on ECMO duration was examined utilizing multivariable logistic regression. Measurements and Main Results: Among the 13,681 patients supported with VV ECMO, 4,040 (29.5%) were supported for ≥21 days and 975 (7.1%) for ≥50 days. Patients supported with prolonged VV ECMO were less likely to be discharged alive from the hospital compared to those with short duration of support (46.5 vs. 59.7; p<0.001). However, among patients supported with VV ECMO ≥21 days, duration of ECLS was not significantly associated with mortality (HR: 0.99; 95% CI: 0.98-1.01, P=0.869, adjusted HR: 0.99; 95% CI: 0.96-1.01, P=0.246). Even in those supported with VV ECMO for at least 120 days (N=113), 52 (46.0%) of these patients were ultimately discharged alive from the hospital. Conclusions: Prolonged VV ECMO support of ARDS has increased and accounts for a substantial portion of cases. Among patients that survive for ≥21 days while receiving VV ECMO support, duration is not predictive of survival to hospital discharge and lung recovery may occur even after very prolonged VV ECMO support.