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Age and associated outcomes among patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory failure: analysis of the Extracorporeal Life Support Organization registry

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Abstract

Purpose

Venovenous extracorporeal membrane oxygenation (VV-ECMO) can be used to support patients with refractory acute respiratory failure, though guidance on patient selection is lacking. While age is commonly utilized as a factor in establishing the potential VV-ECMO candidacy of these patients, little is known regarding its association with outcome. We studied the association between increasing patient age and outcomes among patients with acute respiratory failure receiving VV-ECMO.

Methods

In this registry-based cohort study, we used individual patient data from 144 centres. We included adult patients (≥ 18 years of age) receiving VV-ECMO from 2017 to 2022. The primary outcome was hospital mortality. Secondary outcomes included a composite of complications following initiation of VV-ECMO. We conducted Bayesian analyses to estimate the association between chronological age and outcomes.

Results

We included 27,811 patients receiving VV-ECMO. Of these, 11,533 (41.5%) died in hospital. For the analysis conducted using weakly informed priors, and as compared to the reference category of age 18–29, the age brackets of 30–39 (odds ratio [OR] 1.17, 95% credible interval [CrI] 1.06–1.31), 40–49 (OR 1.65, 95% CrI 1.49–1.82), 50–59 (OR 2.39, 95% CrI 2.16–2.61), 60–69 (OR 3.29, 95% CrI 2.97–3.67), 70–79 (OR 4.57, 95% CrI 3.90–5.37), and ≥ 80 (OR 8.08, 95% CrI 4.85–13.74) were independently associated with increasing hospital mortality. Similar results were found between increasing age and post-ECMO complications.

Conclusions

Among patients receiving VV-ECMO for acute respiratory failure, increasing age is significantly associated with poorer outcomes, and this association emerges as early as 30 years of age.

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Author information

Author notes

  1. Shannon M. Fernando and Daniel Brodie have contributed equally as co-first authors.

  2. Graeme MacLaren and Daniel I. McIsaac have contributed equally as co-senior authors.

Authors and Affiliations

  1. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Shannon M. Fernando & Daniel I. McIsaac

  2. Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada

    Shannon M. Fernando

  3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Daniel Brodie

  4. Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA

    Ryan P. Barbaro

  5. Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA

    Ryan P. Barbaro

  6. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Cara Agerstrand

  7. Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA

    Cara Agerstrand

  8. Department of Emergency Medicine, University of Washington, Seattle, WA, USA

    Jenelle Badulak

  9. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA

    Jenelle Badulak

  10. Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Errol L. Bush

  11. Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany

    Thomas Mueller

  12. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Laveena Munshi & Eddy Fan

  13. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Laveena Munshi & Eddy Fan

  14. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Graeme MacLaren

  15. Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore

    Graeme MacLaren

  16. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada

    Daniel I. McIsaac

  17. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Daniel I. McIsaac

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  1. Shannon M. Fernando
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Contributions

SMF, DB, GM, and DIM conceived the study idea. All authors participated in study design. DIM performed data analyses. All authors interpreted the data analyses. All authors co-wrote and revised the manuscript for intellectual content. All authors provided their final approval for manuscript submission. All authors agree to be accountable for all aspects of the work. SMF and DB are co-first authors. GM and DIM are co-senior authors.

Corresponding author

Correspondence to Shannon M. Fernando.

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Conflicts of interest

SMF has no conflicts to declare. DB receives research support from and consults for LivaNova. He has been on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira, and Cellenkos. He is the President-elect of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Executive Committee of the International ECMO Network (ECMONet), and he writes for UpToDate. RPB is an ELSO Board Member, Co-Chair of the International Pediatric ECMO Research Network (PediECMO) and he receives funding from the National Institutes of Health (NIH) R01 HL153519, outside of the submitted work. CA has no conflicts to declare. JB has no conflicts to declare. ELB has no conflicts to declare. TM serves on the board of the Extracorporeal Life Support Organization. LM has no conflicts to declare. EF reports receiving personal fees from ALung Technologies, Baxter, Getinge, Inspira, Vasomune, and Zoll Medical, outside of the submitted work. GML is President of the Extracorporeal Life Support Organization (ELSO). DIMI receives salary support from The Ottawa Hospital Anesthesia Alternate Funds Association and holds a Research Chair from the University of Ottawa Faculty of Medicine.

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Fernando, S.M., Brodie, D., Barbaro, R.P. et al. Age and associated outcomes among patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory failure: analysis of the Extracorporeal Life Support Organization registry. Intensive Care Med 50, 395–405 (2024). https://doi.org/10.1007/s00134-024-07343-5

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