ID:187 OA2-1 Extracorporeal Membrane Oxygenation in Hematopoietic Stem Cell Transplant Recipients: Nationwide In-Hospital Outcomes in Germany, 2013–2022

Background: Hematopoietic stem cell transplantation (HSCT) carries substantial risk for severe cardiopulmonary complications. Extracorporeal membrane oxygenation (ECMO) may serve as rescue therapy in HSCT recipients with refractory respiratory or circulatory failure; however, nationwide outcome data for this population remain scarce. We aimed to assess in-hospital outcomes of HSCT recipients requiring ECMO support in Germany. Methods: We analyzed nationwide hospital discharge data from the German Federal Statistical Office (Destatis) for all patients who received veno-venous (VV) or veno-arterial (VA) ECMO between January 2013 - December 2022 HSCT identified by ICD-10 and OPS procedure codes. The primary endpoint was in-hospital mortality. Demographics, ECMO modality, underlying diagnoses, comorbidities, and temporal trends were evaluated. Result: Of 157 patients receiving both HSCT and ECMO, 143 (91.1%) died during hospitalization. VV-ECMO was used in 84.7%. Median age was comparable between survivors and non-survivors (35.5 vs. 37 years; p = 0.425). The most frequent underlying diagnoses were acute myeloid leukemia (14.0%), multiple myeloma (11.5%), and diffuse large B-cell lymphoma (10.2%). Coagulopathy was documented in 97.5% of all cases. Renal replacement therapy was required in 63.7% of all cases. Survivors had significantly longer hospital stays (median 112.25 vs. 49.39 days; p <0.0001) and mechanical ventilation duration (median 38.46 vs. 18.08 days; p = 0.004). Conclusion: HSCT recipients requiring ECMO in Germany face in-hospital mortality exceeding 90%, substantially higher than previously reported in single-center studies. The high prevalence of coagulopathy highlights the profound hemostatic derangement in this population. These findings underscore the need for rigorous patient selection, intensified coagulation monitoring, and multidisciplinary protocols when considering ECMO in HSCT recipients.