An observational Epic Cosmos study examined in-hospital outcomes among 42,210 adults receiving ECMO, including venoarterial, venovenous, and hybrid support. Hospital mortality ranged from 37% with venovenous ECMO to 50% with venoarterial ECMO. In models adjusted for demographic and clinical variables, admitting diagnosis group had the strongest association with mortality. Elevated lactate, elevated creatinine, and lower pH within 24 hours before ECMO initiation were also associated with increased mortality, with associations varying by ECMO type. These biomarker findings were exploratory and require further validation.
Pre-ECMO laboratory abnormalities were associated with hospital mortality, but these exploratory findings do not establish biomarker-based candidacy criteria or causal effects.
Study limitation: The abstract provides no biomarker effect sizes or uncertainty intervals, limiting assessment of the magnitude and precision of these associations.
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