(310) ECMO Discontinuation due to Resource Limitation: An ELSO Registry Study

Introduction: Extracorporeal membrane oxygenation (ECMO) is a lifesaving but resource-intensive technology. Low- and middle-income countries face significant challenges during the implementation and maintenance of ECMO programs. Furthermore, the COVID-19 pandemic imposed economic and ethical dilemmas for resource allocation. Limited data are available for those who had ECMO discontinuation due to resource limitation.

Methods: Retrospective ELSO Registry cohort study of all patients who had ECMO discontinuation due to resource limitation between 2013-2023. The primary objective was to describe patient characteristics associated with ECMO discontinuation due to resource limitation and compare pre- (2013-2019) and post- (2020-2023) COVID-19 pandemic eras.

Results: Of the 161,851 ECMO runs during the study period, 359 (0.2%) had discontinuation due to resource limitation. Of those, 74.6% were adults, 17.5% children, and 7.9% neonates. Median age and weight were 46.8 years old (IQR, 17.7-62.1) and 70 kg (IQR, 50-85), respectively. Cardiac ECMO and VA support were the most prevalent (50.9% and 70.2%, respectively). Most common complications were renal (23%), hemorrhagic (18%), and mechanical (15%). Most patients (63.7%) did not survive post decannulation; 25.6% were transported on ECMO to an outside facility for resource allocation; and 10.6% survived decannulation. Discontinuation due to resource limitation peaked in 2019 before the COVID-19 pandemic, down-trended during the pandemic in 2020 and had an uprising trend over the following years. There were no significant differences in demographic data, pre-ECLS support, ECMO type, mode, duration, support characteristics, or complications between pre- and post- COVID-19 pandemic eras. There was a significant increase in decannulations due to resource limitation within North American centers (22% vs 41%, p < 0.001) and in transportations on ECMO to outside facilities worldwide (16% vs 34%, p < 0.001) in the post-COVID-19 pandemic era.

Conclusions: ECMO discontinuation due to resource limitation is uncommon, peaked before the pandemic in 2019 and has increased worldwide over the last years. The specific reasons for decannulation due to resource limitation are unknown and warrant further study.