Age and In-Hospital Mortality in Patients With Acute Respiratory Distress Syndrome Undergoing Venovenous Extracorporeal Membrane Oxygenation

Age is a known risk factor for mortality in acute respiratory distress syndrome (ARDS) patients receiving venovenous extracorporeal membrane oxygenation (VV ECMO), but an optimal age cutoff for patient selection remains unclear. This study evaluates the association between age and in-hospital mortality in ARDS patients undergoing VV ECMO using the National Inpatient Sample from 2019 to 2022. We included adults with ARDS treated with VV ECMO and applied logistic regression to assess mortality risk while adjusting for demographics, comorbidities, hospital settings, and socioeconomic factors. Among an estimated 510,175 ARDS hospitalizations, 13,150 patients received VV ECMO, with an in-hospital mortality rate of 43.4%. The predicted mortality increased linearly with age. Compared with patients aged 18-25 years, the odds ratios (ORs) for mortality were 1.01 (26-35 years), 1.47 (36-45 years), 1.96 (46-55 years), 2.79 (56-65 years), 3.72 (66-75 years), and 4.27 (≥76 years), with statistical significance for older groups. Our findings confirm age as a strong predictor of mortality in this population. However, the absence of a clear threshold suggests that strict age cutoffs may not be justified. Instead, ECMO candidacy should be individualized, emphasizing overall clinical status rather than age alone.