Racial disparities in outcomes for extracorporeal membrane oxygenation in the United States

Racial disparities in extracorporeal membrane oxygenation (ECMO) outcomes in patients with a broad set of indications are not well documented. Adults requiring ECMO were identified in the 2016–2019 National Inpatient Sample. Patient and hospital characteristics, including mortality, clinical outcomes, and resource utilization were analyzed using multivariable regressions. Of 43,190 adult ECMO patients, 67.8% were classified as White, 18.1% Black, and 10.4% Hispanic. Although mortality for Whites declined from 47.5 to 41.0% (P = 0.002), it remained steady for others. Compared to White, Asian/Pacific Islander (PI) race was linked to increased odds of mortalty (AOR = 1.4, 95% CI = 1.1–2.0). Black race was associated with increased odds of acute kidney injury (AOR = 1.4, 95%-CI: 1.2–1.7), while Hispanic race was linked to neurologic complications (AOR 21.6; 95% CI 1.2–2.3). Black and Hispanic race were also associated with increased incremental costs. Race-based disparities in ECMO outcomes persist in the United States. Further work should aim to understand and mitigate the underlying reasons for such findings.