Causes of Death Among Patients Supported by Extracorporeal Membrane Oxygenation

<h3>Background</h3> Mortality for patients who are critically ill receiving extracorporeal membrane oxygenation (ECMO) support (venovenous or venoarterial) is high, but the proximal causes of death have not been characterized fully. <h3>Research Question</h3> We aimed to characterize the reasons for death in patients who underwent cannulation while receiving venoarterial or venovenous ECMO. <h3>Study Design and Methods</h3> This was a retrospective multicenter observational cohort study of adult patients who underwent cannulation for ECMO and who died while receiving ECMO at 6 medical centers in the United States. <h3>Results</h3> We categorized the causes of death for 751 patients who underwent cannulation for ECMO. We summarized and compared baseline patient characteristics among the 6 sites. Reasons for death were comorbid withdrawal of life-sustaining therapy (n = 248 [33%]), progressive hemodynamic shock (n = 200 [27%]), neurologic withdrawal of life-sustaining therapy (n = 135 [18%]), cardiogenic shock (n = 126 [17%]), respiratory failure (n = 31 [4.1%]), and equipment failure (n = 11 [1.5%]). Comorbid withdrawal of life-sustaining therapy was the most common cause of death in patients who underwent cannulation for both venoarterial (n = 141 [29%]) and venovenous (n = 107 [41%]) ECMO. The rate of palliative care consultation differed among sites. <h3>Interpretation</h3> This study showed that most deaths result from comorbid withdrawal of life-sustaining therapy and that death or withdrawal because of refractory respiratory failure and cardiogenic shock account for a lower proportion of deaths in patients receiving ECMO. Our efforts to reduce mortality in patients receiving ECMO should account for the proportion of deaths attributable to comorbid withdrawal of life-sustaining therapy.