Complications and Challenges of Adult Extra-corporeal Membrane Oxygenation (ECMO) in A Tertiary Care Hospital\'s Resource-limited ICU: A Retrospective Cohort Study

BackgroundExtracorporeal Membrane Oxygenation (ECMO) is a vital rescue therapy for severe cardiac or respiratory failure, but its use in resource-limited intensive care units (ICUs) is constrained by infrastructure and staffing limitations. ObjectivesTo evaluate complications, challenges, and outcomes among adult ECMO recipients in a resource-limited tertiary ICU and to identify factors associated with survival. MethodsThis retrospective cohort included adult patients supported with ECMO between June 2023 and March 2025.Demographics, ECMO type, complications, and survival outcomes were analyzed using descriptive statistics, chi-square tests, Fisher's exact tests, and logistic regression in R version 4.5.1. ResultsOf 54 patients receiving ECMO, 11 (20.4%)survived.Veno-venous ECMO was used in 41 (75.9%) patients, with 24.4% (n = 10) survival, whereas veno-arterial ECMO was used in 12 (22.2%)patients, with 8.3% (n = 1) survival.Median ECMO duration was 8 days in survivors versus 12 days in non-survivors.Survivors required 11.3 ventilator days on average, compared with 14.9 days for non-survivors.Mean SOFA scores were 6.4 3.2 (range 2-11) in survivors and 16.5 2.0 (range 10-20) in non-survivors (p < 2/4/26, 2:33 PM ABSTRACTS ECMO -IJECMO2026 file:///C:/Users/Prabhat Shukla.DESKTOP-6HO8CNO/Downloads/Page Proof/IJECMO-4(S1)-html/IJECMO-4(S1)-html/IJECMO-4(S1)/4/S(1)/10.5 1/2 0.05); the SOFA AUROC was 0.997 (95% CI 0.990-1.000),indicating excellent discrimination.Hemodynamic instability (p = 0.029), acute kidney injury (p < 0.05), sepsis (p = 0.023), and bleeding (p = 0.009) were major predictors of mortality. ConclusionsECMO in resource-limited ICUs is associated with high mortality, particularly in the presence of sepsis, bleeding, or hemodynamic instability; early complication recognition and SOFA-guided selection may improve outcomes.