(349) Sepsis-Associated Mortality and Outcomes in Acute Respiratory Distress Syndrome With ECMO

Introduction: Extracorporeal membrane oxygenation (ECMO) use has increased significantly over the last few years among patients with acute respiratory distress syndrome (ARDS). While studies have shown survival benefits with ECMO use, the mortality rate remains high. This study aimed to assess the mortality and other outcomes in ARDS patients who have undergone ECMO with comorbid sepsis.

Methods: The study utilized the National Inpatient Sample from 2016 to 2020 to identify ARDS hospitalizations with ECMO using the International Classification of Disease, 10th revision (ICD-10). The overall study population was further stratified by sepsis status. We matched patients with and without sepsis based on age, sex, race/ethnicity, payer, hospital region, and clinical comorbidities. We used a greedy propensity score matching ratio of 1:1 and compared in-hospital outcomes. The primary outcome was in-hospital mortality, while the secondary outcomes included pulmonary embolism, acute kidney injury requiring dialysis, use of vasopressor, cardiac arrest, length of hospital stay, and cost of hospitalization. Conditional logistic regression was performed to estimate the odds of outcomes.

Results: We identified 18,629 ARDS-ECMO hospitalizations, of which 10,479 (56.3 %) had sepsis. The sepsis cohort was older and white, with a higher prevalence of diabetes mellitus, anemia, liver failure, cancer, HIV, and obesity. After propensity score matching, ARDS-ECMO with Sepsis had more major adverse events, including in-hospital mortality (51.5% vs. 26.9%; OR 2.90, CI: 2.68-3.14), pulmonary embolism (7.3% vs. 4.8%; OR 1.55, CI: 1.34-1.80), acute kidney injury requiring dialysis (75.8% vs. 51.9%; OR 2.86, CI: 2.65-3.10), use of vasopressor (39.4% vs. 27.0%; OR 1.75, CI: 1.62-1.89), cardiac arrest (17.2% vs. 14.3%; OR 1.25, CI: 1.14-1.37), length of hospital stay (Mean(SD): 25.2 (21.9) vs. 17.6(15.7); OR 1.43, CI: 1.40-1.47) and cost of hospitalization (Mean(SD): 124,218(132,192) vs. 88,257(84,177); OR 1.41, CI: 1.37-1.45).

Conclusions: Adults with ARDS who received ECMO with comorbid sepsis had a higher risk of in-hospital mortality and associated outcomes such as pulmonary embolism, acute kidney injury requiring dialysis, vasopressor use, cardiac arrest, increased length of hospital stay and cost of hospitalization.