Abstract
<jats:p>Acute kidney injury (AKI) is a common complication of COVID-19-associated acute respiratory distress syndrome (ARDS), yet the impact of extracorporeal membrane oxygenation (ECMO) on outcomes in this high-risk population remains unclear. We performed a retrospective study using the National Inpatient Sample (NIS) database from 2020–2022 to compare outcomes among adults hospitalized with COVID-19-associated ARDS and AKI managed with invasive mechanical ventilation (IMV) alone versus IMV and ECMO. The primary outcome was in-hospital mortality, while secondary outcomes included renal replacement therapy (RRT), complications, hospital length of stay (LOS), and healthcare utilization. Among 198,395 patients with COVID-19 ARDS complicated by AKI, 4,730 received IMV and ECMO. ECMO was not associated with reduced mortality after multivariable adjustment (adjusted odds ratio [aOR] 0.96, 95% CI 0.81-1.12). However, ECMO was associated with greater odds of RRT, intracranial hemorrhage, disseminated intravascular coagulation, cardiogenic shock, vasopressor use, tracheostomy, acute liver failure, deep vein thrombosis, ischemic stroke and ICU-acquired weakness. ECMO was also associated with longer LOS and higher hospitalization costs. In conclusion, among patients with COVID-19-associated ARDS and AKI, ECMO was not associated with a clear adjusted mortality benefit but was associated with markedly higher complication burden, longer hospitalization, and substantially greater healthcare resource utilization.</jats:p>