Venovenous Extracorporeal Membrane Oxygenation Outcomes in Cirrhosis: An Extracorporeal Life Support Organization Registry Study

Cirrhosis was previously listed in Extracorporeal Life Support Organization (ELSO) guidelines as an absolute contraindication for venovenous extracorporeal membrane oxygenation (VV ECMO) and has since been removed. Minimal data report ECMO outcomes for this population, and thus little guides their ECMO candidacy decisions. We queried the ELSO Registry for all patients with cirrhosis who underwent VV ECMO between January 2014 and August 2024 to characterize outcomes compared with a propensity-matched cohort and to identify predictors of survival. Of 48,267 initial VV ECMO runs, 72 patients had cirrhosis (mean age 52 years, 56% male). Twenty (28%) patients survived to hospital discharge compared with 44% survival in the propensity-matched cohort. There were no statistically significant differences in ECMO complication rates or duration of support. Similarly, there were no statistically significant differences in survival and complication rates between patients with cirrhosis and complicated cirrhosis. Univariate and multivariate regression analyses did not identify reliable predictors of mortality. Overall, ECMO outcomes in patients with cirrhosis are worse than all-comers on ECMO but not substantially different than other broadly accepted ECMO indications such as extracorporeal cardiopulmonary resuscitation (ECPR). Until further data emerge, these data may be helpful to centers considering VV ECMO in patients with cirrhosis.