Predictors of Survival in Extracorporeal Membrane Oxygenation Supported Immunocompromised Acute Respiratory Distress Syndrome Patients

Immunocompromised patients frequently develop acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (VV-ECMO), yet evidence on prognostic factors in this population remains limited. This single-center retrospective study evaluated 90 day outcomes and identified predictors of mortality in immunocompromised ARDS patients supported with VV-ECMO. Between September 2009 and December 2021, 112 ARDS patients (49 immunocompromised and 63 immunocompetent) who received VV-ECMO were included. Baseline characteristics and outcomes were compared between groups; multivariate Cox regression analyzed 90 day mortality predictors, with subgroup analyses by immune status. Ninety day mortality was comparable between nonimmunosuppressed and immunosuppressed patients. Pre-ECMO platelet count <75 × 10 ⁹ /L was the sole independent predictor of 90 day mortality, and this association was observed exclusively in immunocompromised patients. Immunocompromised patients with a platelet count ≥75 × 10 ⁹ /L achieved survival comparable to immunocompetent patients, whereas those with a platelet count <75 × 10 ⁹ /L had fewer ventilator-free and ECMO-free days. Immunocompromised status per se was not independently associated with 90 day mortality in VV-ECMO–supported ARDS patients. Pre-ECMO platelet count emerged as a critical risk stratification tool: immunocompromised patients with a platelet count ≥75 × 10 ⁹ /L demonstrated favorable outcomes, whereas those with lower counts were at substantially increased risk.