OBJECTIVES: To report outcomes of immunocompromised patients treated with extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) and to identify their pre-ECMO predictors of 6-month mortality and main ECMO-related complications.

METHODS: Retrospective multicenter study in 10 international intensive care units (ICUs) with high ECMO-case volumes. Immunocompromised patients, defined as having hematological malignancies, active solid tumor, solid-organ transplant, acquired immunodeficiency syndrome, or long-term or high-dose corticosteroid or immunosuppressant use, and severe ECMO-treated ARDS from 2008 to 2015 were included Measurements and Main Results: We collected demographics, clinical, ECMO-related complications, ICU- and 6-month-outcome data for 203 patients (median APACHE II 28 [25th ;75th percentile, 20;33]; age 51 [38;59] years, PaO2/FiO2 60 [50;82] mmHg before ECMO) who fulfilled our inclusion criteria. Six-month survival was only 30%, with a respective median ECMO duration and ICU stay of 8 [5;14] and 25 [16;50] days. Patients with hematological malignancies had significantly poorer outcomes than others (log-rank P=0.02). Multivariate analyses retained <30 days between immunodeficiency diagnosis and ECMO cannulation as being associated with lower 6-month mortality (odds ratio 0.32 (95% confidence interval 0.16-0.66); P=0.002), and lower platelet count, higher PCO2, age and driving pressure as independent pre-ECMO predictors of 6-month mortality.

CONCLUSION: Recently diagnosed immunodeficiency is associated with a much better prognosis in ECMO-treated severe ARDS. However, low 6-month survival of our large cohort of immunocompromised patients supports restricting ECMO to patients with realistic oncological/therapeutic prognoses, acceptable functional status and few pre-ECMO mortality-risk factors.