(1157) Association of Alcohol Use Disorder on Extracorporeal Membrane Oxygenation Outcomes

Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with severe respiratory failure. However, the outcomes while on ECMO therapy are dependent upon patient comorbidities. Prior studies have linked chronic alcohol use to an elevated risk of acute lung injury and acute respiratory distress syndrome (ARDS); however, limited knowledge exists regarding outcomes of patients with alcohol use disorder (AUD) who receive ECMO treatment. This study aims to investigate the mortality risks associated with ECMO therapy in patients with AUD.

Methods: A retrospective analysis was conducted using TriNetX, a global database of patient data derived from electronic medical records, to evaluate ARDS patients aged 18 years or older who had received treatment with ECMO in the United States between July 2008 and July 2020. The patients were initially classified using ICD-10 codes into two groups based on whether they had received a diagnosis of AUD. Subsequent analysis of patient characteristics was performed with data propensity matched for age and sex.

Results: The study initially identified 1,712 patients who developed ARDS and received ECMO treatment (222 ECMO+/AUD+, 1,490 ECMO+/AUD-); 96,897 ARDS patients served as controls (14,075 ECMO-/AUD+, 82,822 ECMO-/AUD-). After propensity score matching, 221 patients remained in each cohort (172 males; mean age, 45.5 ± 15.2 years). Comparison analysis revealed significant differences in 90-day mortality between the two ECMO+ groups, with AUD+ patients exhibiting markedly lower rates of mortality (p < 0.001; RR = 0.68). Notably, this result was specific to the AUD+ cohort, and was not observed in patients with other substance use disorders (SUD) (p = 0.37, RR = 0.87). When compared with the control group, there were no significant differences in ECMO usage between ARDS patients with and without AUD (p = 0.07, RR = 0.88).

Conclusions: Our findings suggest that AUD is associated with a lower mortality rate in ARDS patients receiving ECMO. It is unclear why prior work has showed that AUD increases the incidence of ARDS without worsening ECMO mortality. Further research is needed to elucidate the underlying mechanisms and consider the implications for clinical decision-making and management of patients with AUD in the context of ECMO therapy.