Outcomes and survival prediction in adults with sickle cell disease treated with extracorporeal membrane oxygenation.

The utility of extracorporeal membrane oxygenation (ECMO) support for adult patients with sickle cell disease (SCD) remains poorly understood. We aimed to characterize a cohort of adult individuals with SCD in the Extracorporeal Life Support Organization (ELSO) registry who underwent venoarterial (VA) or venovenous (VV) ECMO treatment, assess clinical outcomes for each modality and determine predictors of mortality. This multicenter, retrospective study evaluated in-hospital mortality and clinical outcomes such as bleeding and thrombotic events (BTE) of adult VA and VV ECMO ELSO registry patients with SCD associated ICD-9/10-CM codes. Post hoc multivariable logistic regression model was developed assessing predictors of mortality. Of 206 included patients, 126 and 80 were cannulated for VA ECMO or VV ECMO, respectively. Eighty-three patients (40.3%) were discharged alive; In-hospital survival was 25.5% and 61.1% for VA and VV ECMO, respectively (p<0.001). BTE was common during VA (45.6%) and VV (33.8%) ECMO support. There was significant increase in BTE incidence for non-survivors compared to survivors with VA ECMO (55.4% vs. 26.5%, p<0.001) and VV ECMO (58.1% vs. 18.4%, p=0.01). Male sex, increased age, pre-ECLS cardiac arrest, cannulation for eCPR, and elevated lactate were predictive of in-hospital mortality in the VA ECMO cohort. In adult patients with SCD, in-hospital survival was significantly lower with VA ECMO compared to VV ECMO. Male sex, increased age, eCPR support, elevated lactate and pre-ECLS arrest were strongest indicators of VA ECMO mortality. Bleeding and thrombotic complications have an association with in-patient mortality for those treated with ECMO.