Purpose: The outcomes of immunocompromised patients with cardiogenic shock treated with venoarterial extra‑corporeal membrane oxygenation (VA‑ECMO) are seldom documented, making ECMO candidacy decisions challeng‑ing. This study aims (1) to report outcomes of immunocompromised patients treated with VA‑ECMO, (2) to identify pre‑ECMO predictors of 90‑day mortality, (3) to assess the impact of immunodepression on 90‑day mortality, and (4) to describe the main ECMO‑related complications.Methods: This is a retrospective, propensity‑weighted study conducted in two French experienced ECMO centers.

Results: From January 2006 to January 2022, 177 critically ill immunocompromised patients (median (interquartile range, IQR) age 49 (32–60) years) received VA‑ECMO. The main causes of immunosuppression were long‑term corti‑costeroids/immunosuppressant treatment (29%), hematological malignancy (26%), solid organ transplant (20%), and solid tumor (13%). Overall 90‑day and 1‑year mortality were 70% (95% confidence interval (CI) 63–77%) and 75% (95% CI 65–79%), respectively. Older age and higher pre‑ECMO lactate were independently associated with 90‑day mortal‑ity. Across immunodepression causes, 1‑year mortality ranged from 58% for patients with infection by human immu‑nodeficiency virus (HIV) or asplenia, to 89% for solid organ transplant recipients. Hemorrhagic and infectious com‑plications affected 39% and 54% of patients, while more than half the stay in intensive care unit (ICU) was spent on antibiotics. In a propensity score‑weighted model comparing the 177 patients with 942 non‑immunocompromised patients experiencing cardiogenic shock on VA‑ECMO, immunocompromised status was independently associated with a higher 90‑day mortality (odds ratio 2.53, 95% CI 1.72–3.79).

Conclusion: Immunocompromised patients undergoing VA‑ECMO treatment face an unfavorable prognosis, with higher 90‑day mortality compared to non‑immunocompromised patients. This underscores the necessity for thor‑ough evaluation and careful selection of ECMO candidates within this frail population.