Abstract Body: Background
Extracorporeal membrane oxygenation (ECMO) is a life-saving support for refractory cardiopulmonary failure. However, complications such as acute kidney injury (AKI), disseminated intravascular coagulation (DIC), intracranial hemorrhage (ICH), and acute ischemic stroke (AIS) remain common and impact outcomes. Understanding their associations with ECMO is essential to improve care and resource use.

Research Question
How do AKI, DIC, ICH, and AIS affect in-hospital mortality in ECMO patients, and what is their association with length of stay (LOS) and hospital charges?

Aims
The study aimed to evaluate the impact of AKI, DIC, ICH, and AIS on in-hospital mortality among ECMO patients. Secondary aims included assessing their association with length of stay and hospital costs.

Methods
We conducted a retrospective cross-sectional analysis of adult ECMO hospitalizations from the 2018–2022 National Inpatient Sample (NIS) sample, identified using ICD-10-PCS codes. Complications—AKI, DIC, ICH, and AIS—were identified via ICD-10-CM codes. The primary outcome was in-hospital mortality; secondary outcomes were LOS (days) and log-transformed hospital charges. Survey-weighted logistic regression assessed associations with mortality, while linear regression analyzed LOS and charges. A complication burden score (0–4) reflected the number of complications per case. Models were adjusted for demographics, insurance, income, and hospital characteristics.

Results
Among an estimated 55,150 ECMO hospitalizations in the U.S. (2018–2022), in-hospital mortality was 44.6%. AKI was most common (69.1%), followed by DIC (7.5%), AIS (7.1%), and ICH (3.4%). All were independently linked to higher mortality. Adjusted odds ratios (aOR) were highest for ICH (3.94; 95% CI, 3.02–5.14), then DIC (2.45; 2.06–2.92), AKI (1.84; 1.67–2.02), and AIS (1.42; 1.20–1.68); all p<0.001. Observed mortality was highest in ICH (71.5%), DIC (63.3%), AIS (52.9%), and AKI (48.7%). Complications also increased resource use. AKI had the greatest impact on LOS (+5.88 days, p<0.001) and charges (+41.4%, p<0.001); AIS and DIC also raised both outcomes. A complication burden score (0–4) showed each 1-point rise associated with 68% higher mortality odds (aOR 1.68, p<0.001) and +4.8 days in LOS (p<0.001).

Conclusion
ECMO complications significantly worsen mortality and increase LOS and cost. Targeted strategies to prevent or mitigate these complications may improve outcomes and reduce resource use.