Socioeconomic status and ECMO outcomes in severe ARDS

Background: Socioeconomic inequalities have been associated with adverse outcomes in critically ill COVID-19 patients. Whether these disparities extend to the most severe ARDS patients treated with ECMO, regardless of etiology, remains uncertain. We aimed to compare the socioeconomic profiles, management, and outcomes of COVID-19 ARDS patients on ECMO with those treated for ARDS due to other causes, using the nationwide French healthcare database. Results: From March 2015 to December 2021, 1722 adults received ECMO for acute respiratory failure: 1245 with COVID-19, 107 with influenza, and 370 with other causes. Overall, 27% lived in the most deprived neighborhoods, with consistent overrepresentation across etiologies (26.8% COVID-19, 29% influenza, 25.3% other) compared to less deprived neighborhoods (p = 0.039). In-hospital mortality was 56% in COVID-19, 48% in influenza, and 60% in other causes (p = 0.080). Median ICU stay was longest in COVID-19 survivors (56 [36-78] days), who also required longer ECMO support and experienced more complications. Independent predictors of in-hospital death included older age and need for renal replacement therapy at ECMO initiation, while socioeconomic deprivation was not associated with outcomes. After adjustment, mortality was higher in non-COVID-19, non-influenza patients compared with influenza (Odds ratio 1.70, 95% confidence interval [1.03-2.81]). Conclusions: Severe ARDS requiring ECMO disproportionately affected patients from socioeconomically deprived areas, irrespective of etiology. However, deprivation was not linked to worse outcomes.