Background: Mortality and complication rates remain high with VA-ECMO. Understanding risk factors for mortality and post-ECMO functional status may aid conversations about prognosis.

Methods: ELSO Registry data for adults supported with VA-ECMO from 2018-2022 were used to calculate proportions of three outcomes: death after ECMO withdrawal, death after ECMO liberation, and survival to hospital discharge. For patients liberated, we calculated proportions of: discharge home, discharge to facility, or death. We used generalized linear mixed models to measure associations between predictors and different outcomes, using random intercepts to account for within-site correlation.

Results: 24,530 patients were supported with VA-ECMO (33% female, 61% white, mean age 55.6 years). ECMO withdrawal occurred in 43.4%, 12.4% were liberated but died prior to discharge, and 44.2% survived to discharge. Within-site, higher odds of withdrawal versus survival were observed in older age (1.03 per year, p<0.001), pre-ECLS arrest (1.36, p<0.001), higher flow at 24 hours (1.11, p<0.001), and renal replacement therapy (2.14, p<0.001). Findings were similar for death following liberation versus survival. Higher odds of discharge home versus facility were observed for those who were mobile (1.56, p<0.001), and lower odds for those with major complications (0.39, p<0.001). Findings were similar for discharge home vs death.

Conclusion: Markers of illness severity at ECMO initiation were associated with withdrawal of ECMO and death following liberation. Discharge to a facility was more common than discharge home, however the odds of discharge home were higher for those who had minor or no complications and were mobile while receiving ECMO.