Extracorporeal Membrane Oxygenation for Severe Hypoxemia in Burn Patients: Analysis from Taiwan National Health Insurance Research Database

Background: Burn patients with severe inhalation injury and refractory hypoxemia are at high risk for cardiorespiratory failure and mortality. Extracorporeal membrane oxygenation (ECMO) has emerged as a potential rescue therapy, but its survival benefits in this population remain uncertain. This study aimed to evaluate the impact of ECMO on mortality in burn patients with severe lung injury, to identify risk factors associated with death, and to analyze causes of rehospitalization among survivors. Methods: We conducted a population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD). Burn patients with severe hypoxia requiring mechanical ventilation between 2000 and 2015 were identified. A 0.25-fold propensity score matching was applied based on age, gender, and burn severity. Mortality rates, survival risk factors, and rehospitalization causes were analyzed between ECMO and non-ECMO groups. Results: Among 6493 eligible patients, ECMO-treated patients had a hospital mortality rate of 47.09%, compared to 38.71% in the non-ECMO group. Early-phase mortality was higher among ECMO patients (adjusted 1-year mortality HR: 3.19), but survivors demonstrated stable long-term outcomes. Pulmonary complications, cardiac dysfunction, and sepsis were the leading causes of death. Kidney failure and infections were the most common reasons for rehospitalization among survivors. Conclusions: This research offers a comprehensive real-world analysis of the effectiveness of ECMO in burn patients. While ECMO does not eliminate early mortality risk, it may provide critical support during acute phase in carefully selected burn patients with severe hypoxemia. Multidisciplinary care and early rehabilitation planning are essential to improve long-term outcomes. Further research is needed to refine patient selection and optimize ECMO strategies in this high-risk population.