Abstract Rationale The role of extracorporeal membrane oxygenation (ECMO) in hematologic malignancies remains controversial due to historically poor outcomes and bleeding risk. Recent advances in ECMO technology and leukemia-directed therapy have renewed interest in its selective use. National data on ECMO utilization and outcomes in acute leukemias remain limited. We aimed to characterize ECMO use, patient characteristics, and in-hospital outcomes in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) using a large national database. Methods We conducted a retrospective cohort study using the National Inpatient Sample (2018-2022). Patients who underwent non-operative ECMO were identified and stratified by a primary diagnosis of AML or ALL. The primary outcome was in-hospital mortality compared with all other ECMO admissions. Secondary outcomes included ECMO type (veno-arterial VA vs veno-venous VV), demographics, and complications (bleeding, embolism, thrombosis). Multivariable logistic regression estimated adjusted odds ratios (aOR) controlling for age, gender, race, and comorbidities. Categorical variables were compared using chi-square testing. Results Among 65,220 ECMO hospitalizations, 345 (0.5%) had a primary diagnosis of a hematologic emergency. The most common ECMO indications overall were COVID-19, sepsis, and acute coronary syndrome. Patients with hematologic emergencies were younger (mean age 13.7 for ALL and 30.2 for AML vs 44.5 years for others) and had higher Charlson Comorbidity Index scores (3.1 vs 2.1). They were more likely to be Hispanic (23.0% vs 14.4%) or Asian (11.5% vs 3.6%) (all p 0.005). No differences were seen in gender or socioeconomic status. In-hospital mortality was higher among ECMO patients with hematologic emergencies (69.6% vs 43.3%, p 0.005) with increased adjusted odds of death (aOR 3.1; 95% CI, 1.7-5.5; p 0.005). VA ECMO was more frequent (63.8%) than VV ECMO (36.2%), with no mortality difference. Mortality was similar between AML and ALL (70.3% vs 68.7%, p = 0.9). Rates of bleeding, embolic, and thrombotic complications were comparable between groups. Conclusions ECMO use in acute leukemia is rare and associated with substantially higher mortality than other indications. Nonetheless, its continued use in younger patients reflects growing openness to reconsider ECMO in hematologic emergencies. The absence of excess hemorrhagic or thrombotic complications challenges assumptions that leukemia universally precludes ECMO. These findings highlight the need for refined selection criteria and multidisciplinary evaluation to identify patients most likely to benefit from this high-risk intervention. This abstract is funded by: None
Prasad et al. (Fri,) studied this question.