Impact of post-decannulation high fever on mortality in patients with severe ARDS treated with veno-venous ECMO: a multicenter retrospective study

Background Few studies have examined the prognostic impact of high fever after decannulation from veno-venous extracorporeal membrane oxygenation (V-V ECMO) in patients with severe acute respiratory distress syndrome (ARDS). We aimed to investigate the incidence and prognostic significance of post-decannulation high fever in this population. Methods This multicenter retrospective study included adult patients with severe ARDS successfully liberated from V-V ECMO between 2012 and 2022 across 24 institutions in Japan. High fever was defined as a core body temperature ≥ 39.0°C within 3 days post-decannulation. The primary outcome was 90-day in-hospital mortality, analyzed using multivariable Cox regression stratified by the presence of infectious complications. Results Among 522 patients, 121 (23.2%) developed high fever after ECMO decannulation. In patients with infection at decannulation, high fever was associated with lower mortality (18.5% vs. 41.5%, p = 0.016). Conversely, in patients without infection, high fever was linked to higher mortality (19.4% vs. 10.7%, p = 0.028). Multivariable analysis showed high fever was associated with reduced mortality in patients with infection (hazard ratio [HR] 0.29; 95% confidence interval [CI] 0.10–0.82; p = 0.034) but increased mortality in those without infection (HR 2.25; 95% CI 1.23–4.12; p = 0.011). Conclusions Post-decannulation high fever occurs in nearly one-fourth of patients with severe ARDS treated with V-V ECMO. Its association with mortality varies according to infection status at decannulation, underscoring the importance of careful assessment of infectious complications in this context.