What is the survival rate after Extracorporeal Membrane Oxygenation (ECMO) placement?

Survival Rates After ECMO Placement

Survival rates after ECMO placement vary significantly by patient population and indication, with adult survival ranging from 24% to 58% and pediatric survival ranging from 35% to 59% depending on age and underlying condition. 1

Overall Survival Rates

Adult Patients

• Hospital discharge survival: 45-58% overall 1, 2
• Survival varies by timeframe:
  • 3-day survival: 76%
  • 30-day survival: 38-47%
  • 5-year survival: 24% 1
• Prolonged ECMO (≥14 days) survival: 45.4% 2

Pediatric Patients

• Age-dependent survival:
  • <30 days of age: 35-40%
  • 31 days to 1 year: 47-49%
  • 1-16 years: 58-59% 1

Factors Affecting Survival

Indication-Specific Survival

• Acute myocarditis: Significantly better outcomes
  • Pediatric: 83% survival
  • Adult: 75% survival 1
• Respiratory failure: 66% survival in specialized centers 3
• Post-cardiopulmonary resuscitation (ECPR): 44% survival 4

Prognostic Factors

Multivariate analysis shows survival is independently associated with:

• Younger age (OR: 0.983; 95% CI, 0.974-0.993) 2
• Lower PaCO₂ before ECMO (OR: 0.991; 95% CI, 0.986-0.996) 2
• Duration of ECMO support:
  • Patients transitioned from ECMO to mechanical circulatory support within 14 days: 92% survival
  • Patients supported longer than 14 days: 25% survival 5

Temporal Trends in Survival

• Recent improvements: Patients treated with prolonged ECMO during 2007-2013 had lower risk of death compared to 1989-2006 (OR: 0.650; 95% CI, 0.454-0.929) 2
• Increasing ECMO duration did not alter the survival fraction in the 1989-2013 study cohort 2

Common Complications Affecting Survival

• Bleeding complications are common despite anticoagulation 1
• Thrombotic and thromboembolic complications:
  • Venous thrombus formation in approximately one-third of patients
  • Systemic thromboembolic events 1
• Youngest patients are at greatest risk for both bleeding and thrombotic complications 1

Clinical Implications

• ECMO should be considered early in appropriate candidates with severe respiratory or cardiac failure
• For patients bridging to other mechanical support, ECMO duration should ideally be less than 14 days 5
• Proper anticoagulation management is critical to balance bleeding and thrombotic risks
• Patient selection is crucial, with better outcomes in specific conditions like acute myocarditis 1

Despite the critical condition of patients requiring ECMO, survival rates have improved over time with advances in technology and management protocols. The decision to implement ECMO should consider the underlying condition, age, and potential for recovery.