• Abhimanyu Chandel, Kimberly D Fabyan, Sondra Mendelsohn, Nitin Puri, Emily Damuth, Craig R Rackley, Steven A Conrad, Christopher S King, and Adam Green.
• Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD.
• Crit. Care Med. 2024 Jun 1; 52 (6): 869877869-877.

ObjectivesTo examine trends in utilization and outcomes among patients with the acute respiratory distress syndrome (ARDS) requiring prolonged venovenous extracorporeal membrane oxygenation (VV ECMO) support.DesignRetrospective observational cohort study.SettingAdult patients in the Extracorporeal Life Support Organization registry.PatientsThirteen thousand six hundred eighty-one patients that required ECMO for the support of ARDS between January 2012 and December 2022.InterventionsNone.Measurements And Main ResultsMortality while supported with VV ECMO and survival to hospital discharge based on ECMO duration were examined utilizing multivariable logistic regression. Among the 13,681 patients supported with VV ECMO, 4,040 (29.5%) were supported for greater than or equal to 21 days and 975 (7.1%) for greater than or equal to 50 days. Patients supported with prolonged VV ECMO were less likely to be discharged alive from the hospital compared with those with short duration of support (46.5% vs. 59.7%; p < 0.001). However, among patients supported with VV ECMO greater than or equal to 21 days, duration of extracorporeal life support was not significantly associated with mortality (odds ratio [OR], 0.99; 95% CI, 0.98-1.01; p = 0.87 and adjusted OR, 0.99; 95% CI, 0.97-1.02; p = 0.48). Even in those supported with VV ECMO for at least 120 days (n = 113), 52 (46.0%) of these patients were ultimately discharged alive from the hospital.ConclusionsProlonged VV ECMO support of ARDS has increased and accounts for a substantial portion of cases. Among patients that survive for greater than or equal to 21 days while receiving VV ECMO support, duration is not predictive of survival to hospital discharge and clinical recovery may occur even after very prolonged VV ECMO support.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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