Purpose: Venovenous extracorporeal membrane oxygenation (VV-ECMO) can be used to support patients with refractory acute respiratory failure, though guidance on patient selection is lacking. While age is commonly utilized as a factor in establishing the potential VV-ECMO candidacy of these patients, little is known regarding its association with outcome. We studied the association between increasing patient age and outcomes among patients with acute respiratory failure receiving VV-ECMO.

Methods: In this registry-based cohort study, we used individual patient data from 144 centres. We included adult patients (≥ 18 years of age) receiving VV-ECMO from 2017 to 2022. The primary outcome was hospital mortality. Secondary outcomes included a composite of complications following initiation of VV-ECMO. We conducted Bayesian analyses to estimate the association between chronological age and outcomes.

Results: We included 27,811 patients receiving VV-ECMO. Of these, 11,533 (41.5%) died in hospital. For the analysis conducted using weakly informed priors, and as compared to the reference category of age 18–29, the age brackets of 30–39 (odds ratio [OR] 1.17, 95% credible interval [CrI] 1.06–1.31), 40–49 (OR 1.65, 95% CrI 1.49–1.82), 50–59 (OR 2.39, 95% CrI 2.16–2.61), 60–69 (OR 3.29, 95% CrI 2.97–3.67), 70–79 (OR 4.57, 95% CrI 3.90–5.37), and ≥ 80 (OR 8.08, 95% CrI 4.85–13.74) were independently associated with increasing hospital mortality. Similar results were found between increasing age and post-ECMO complications.

Conclusions: Among patients receiving VV-ECMO for acute respiratory failure, increasing age is significantly associated with poorer outcomes, and this association emerges as early as 30 years of age.