Sato Ryota, Hamahata Natsumi T, Hasegawa Daisuke, Itoman Erick
From the Division of Critical Care, Department of Medicine, The Queen's Medical Center, Honolulu, Hawaii.
Aloha Critical Care Associates, Hawaii.
ASAIO J. 2025 Sep 1;71(9):760-766. doi: 10.1097/MAT.0000000000002491. Epub 2025 Jun 26.
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.
年龄是接受静脉-静脉体外膜肺氧合（VV ECMO）治疗的急性呼吸窘迫综合征（ARDS）患者死亡的已知风险因素，但患者选择的最佳年龄界限仍不明确。本研究利用2019年至2022年的全国住院患者样本，评估接受VV ECMO治疗的ARDS患者年龄与院内死亡率之间的关联。我们纳入了接受VV ECMO治疗的ARDS成年患者，并应用逻辑回归分析评估死亡风险，同时对人口统计学、合并症、医院环境和社会经济因素进行了调整。在估计的510,175例ARDS住院病例中，13,150例患者接受了VV ECMO治疗，院内死亡率为43.4%。预测死亡率随年龄呈线性增加。与18 - 25岁的患者相比，26 - 35岁、36 - 45岁、46 - 55岁、56 - 65岁、66 - 75岁和≥76岁患者的死亡比值比（OR）分别为1.01、1.47、1.96、2.79、3.72和4.27，老年组具有统计学意义。我们的研究结果证实年龄是该人群死亡的有力预测因素。然而，由于缺乏明确的阈值，严格的年龄界限可能不合理。相反，ECMO治疗的候选资格应个体化，强调整体临床状况而非仅年龄因素。
