V-V ECMO for refractory near-fatal asthma: A 12-year single-centre observational study of clinical outcomes and psychological impact

OBJECTIVES To review the clinical data of adult patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) for near-fatal asthma at a single UK respiratory ECMO centre, including morbidity and mortality follow up. DESIGN Retrospective single-centre case series (2013-2025). SETTING A specialized UK respiratory ECMO centre. PARTICIPANTS 79 adult patients with near-fatal asthma refractory to maximal conventional critical care management including mechanical ventilation. INTERVENTIONS Veno-venous extracorporeal membrane oxygenation. MEASUREMENTS & MAIN RESULTS 79 patients (median age 35 years, 53% female and 47% male) were included. Pre-ECMO physiological derangement was profound (median pH 7.05, PaCO2 14.7 kPa). Median ECMO duration was 3 days (IQR 2-4). Survival to ICU discharge and 6-month survival was 98.7%. Complications occurred in 27.8% of patients, most frequently acute kidney injury requiring renal replacement therapy (10.1%). At 6-month follow-up, clinically significant anxiety and depression were present in 27.9% and 20.9% of survivors, respectively, while 37.2% screened positive for post-traumatic stress symptoms. CONCLUSIONS Veno-venous extracorporeal membrane oxygenation (VV-ECMO) represents an effective rescue therapy for patients with refractory near-fatal asthma, demonstrating excellent short- and long-term survival outcomes when applied in carefully selected cases. The incidence of complications remains acceptable and manageable within this context. The prevalence of anxiety and depression in this cohort appears to be lower than that reported in a published systematic review of the broader ECMO population; however, rates of post-traumatic stress symptoms are comparatively higher.