Objective The pattern and timing of palliative care utilisation and end-of-life characteristics in extracorporeal membrane oxygenation (ECMO)-supported patients remain underused. We wanted to share our centre’s experience.

Methods This is an institutional review board-approved retrospective study of 45 patients who underwent ECMO at a large ECMO centre in North America between January 2013 and July 2018.

Results Only 28.9% of the ECMO patients received in-hospital palliative care consultation at a median of 18 days (IQR 12–31) after hospitalisation and 10.5 days (IQR 1–28) from ECMO initiation. 1-year mortality was high, with 44% dying during hospitalisation and an additional 13% within the following year. Patients experienced prolonged hospitalisations (median hospital length of stay: 39 days, IQR 19–89) and exhibited high rates of tracheostomy (53%) and renal replacement therapy (60%). Most end-of-life cases involved the withdrawal of life-sustaining therapy during ECMO, yet only 53% had a completed living will.

Conclusion Our study underscores the need for early initiation of palliative care consultation to enhance symptom management, advance care planning, caregiver support and quality of life for ECMO patients and their families.