Analysis of ECMO Outcomes in Patients with Known Adrenal Insufficiency: Insights from the National Inpatient Sample Database

Adrenal crises occur due to either a complete lack or an insufficient amount of cortisol and are usually triggered by stressors like infections, trauma, surgical interventions, and dental procedures. The physiological changes associated with major surgery are well-studied stressors linked to adrenal crisis. Extracorporeal membrane oxygenation (ECMO), a strategy employed to assist with circulatory support and gas exchange, is also a significant physiologically demanding stressor to the human body. In this study, we retrospectively assess the incidence and outcomes of patients with adrenal insufficiency who were cannulated for extracorporeal membrane oxygenation (ECMO) using the National Inpatient Sample (NIS) database. Patients who were cannulated for ECMO from 2016 to 2020 were identified and divided into two cohorts depending on the presence or absence of adrenal insufficiency. The two groups were compared for the primary outcome of inpatient mortality and secondary outcomes including rates of LVAD, heart transplant, lung transplantation, stroke, GI bleed, and renal failure. In our study, we found that mortality rates between the two groups were similar. All-cause inpatient mortality was 45% in both groups (p>0.9). We found no differences in the rates of heart transplantation, lung transplantation, or LVAD implantation between patients with and without adrenal insufficiency. We additionally find that mortality rates in our study mirror those from dedicated ECMO registries, further lending credence to our findings. Our study discusses important findings from a relatively understudied disease process, based on a large and representative population from multiple centers across the country.