ECMO Therapy in Intensive Care Settings: A Global Perspective on Outcomes and Observational Practices – Examining Factors Associated With ECMO Survival
Abstract Background: In Saudi Arabia, the use of extracorporeal life support has expanded since the COVID-19 pandemic; however, its use is linked with high mortality rate. Specifically, Extracorporeal Membrane Oxygenation (ECMO) is associated with an increased risk of mortality for patients with chronic conditions, and limited studies have examined the impact of comorbidities on patients’ survival. The Saudi Arabian healthcare system faces various challenges, including resource limitations, unequal allocation of healthcare personnel, and limited clinical data to guide patient selection criteria and the timing of venoarterial ECMO initiation. Purpose/Aims: Identify factors associated with survival among patients receiving ECMO in Saudi Arabia, to identify patients with likelihood of survival, and to inform patient selection criteria, prioritize care, and guide resource allocation. Methods: A retrospective, descriptive, correlational design, with patients who received ECMO therapy in an intensive care setting (N = 115) at a Specialist Hospital in Riyadh, Saudi Arabia. The inclusion criteria are patients admitted with a primary diagnosis requiring ECMO, patients over 18 years of age and admitted between January 2020 and May 2025. Exclusion criteria are patients under 18 years, pregnant women, and patients admitted outside the time frame. Results: A total of 115 patients were included in the analysis. The overall mortality rate was 63.5%. Mortality on ECMO was associated with comorbid connective tissue/ rheumatic disease with p = .047 and renal disease p = .015. ECMO-related complications (infection, renal dysfunction, neurological dysfunction), and time to ECMO initiation were also significantly associated with mortality, with p < .05. Regression analysis with ECMO-related complications (infection, renal, neurological) and time to ECMO initiation highlighted the multifactorial nature of ECMO-related mortality for this cohort, evidenced by the overall significance of the regression model (p < .001) with no individual predictors reaching statistically significance. Implications: The implication of this study suggests how to improve patient selection and optimize utilization, how better education approaches and policies can lead to more accurate clinical judgments and decision making regarding ECMO therapy, and how future research regarding standardized risk-adjusted models across multicenter settings can help identify those most likely to benefit from ECMO.
ECMO-mortality, ECMO complications, time to initiation, Critical Care Nursing, Medicine and Health Sciences
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