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Background <p>Few studies have examined the prognostic impact of high fever after decannulation from veno-venous (V-V) extracorporeal membrane oxygenation (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, exploring its association with mortality, stratified by the presence of infectious complications at decannulation.</p> Methods <p>This study was a post hoc analysis of a multicenter retrospective registry that included adult patients with severe ARDS who were successfully weaned off V-V ECMO between 2012 and 2022 across 24 institutions in Japan. High fever was defined as a core body temperature of ≥ 39.0&#xa0;°C within 3&#xa0;days after ECMO decannulation. The primary outcome was 90-day in-hospital mortality. Cox proportional hazards models were used to examine the association between post-decannulation high fever and mortality. As a subgroup analysis, we evaluated this association according to the presence or absence of infectious complications.</p> Results <p>Among 522 patients, 121 (23.2%) developed high fever within 3&#xa0;days after ECMO decannulation. In the overall cohort, 90-day in-hospital mortality did not differ significantly between the high-fever and no-fever groups (19.0% vs. 13.7%, <i>p</i> = 0.372). Multivariable analysis showed no statistically significant association between high fever and mortality (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.55–1.56, <i>p</i> = 0.770). Subgroup analyses revealed opposite associations depending on infection status. High fever was associated with reduced mortality in patients with infection (HR 0.33, 95% CI 0.12–0.89, <i>p</i> = 0.045) but increased mortality in those without (HR 2.25, 95% CI 1.23–4.11, <i>p</i> = 0.011).</p> Conclusions <p>Post-decannulation high fever occurs in nearly one-fourth of patients with severe ARDS treated with V-V ECMO. Its association with mortality appears to differ depending on the infection status at decannulation, underscoring the importance of carefully assessing infectious complications.</p>

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

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  • 发表日期：

    2026年2月11日

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  • Kenji Fujizuka,
  • Mitsuaki Nishikimi,
  • Kazuya Kikutani,
  • Ryo Emoto,
  • Shinichiro Ohshimo,
  • Shigeyuki Matsui,
  • Nobuaki Shime,
  • Hiroyuki Suzuki,
  • Junki Ishii,
  • Jun Hamaguchi,
  • Kazuki Matsumura,
  • Keiki Shimizu,
  • Mitsunobu Nakamura,
  • Mamoru Masuda,
  • Yoshihiro Hagiwara,
  • Takayuki Ogura,
  • Ryuichi Nakayama,
  • Naofumi Bunya,
  • Junichi Maruyama,
  • Yosuke Matsumura,
  • Yoshitaka Ogata,
  • Yu Amemiya,
  • Masayuki Yagi,
  • Yutaro Furukawa,
  • Hayato Taniguchi,
  • Noriyuki Hattori,
  • Shinichi Kai,
  • Tokuji Ikeda

摘要

Background

Few studies have examined the prognostic impact of high fever after decannulation from veno-venous (V-V) extracorporeal membrane oxygenation (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, exploring its association with mortality, stratified by the presence of infectious complications at decannulation.

Methods

This study was a post hoc analysis of a multicenter retrospective registry that included adult patients with severe ARDS who were successfully weaned off V-V ECMO between 2012 and 2022 across 24 institutions in Japan. High fever was defined as a core body temperature of ≥ 39.0 °C within 3 days after ECMO decannulation. The primary outcome was 90-day in-hospital mortality. Cox proportional hazards models were used to examine the association between post-decannulation high fever and mortality. As a subgroup analysis, we evaluated this association according to the presence or absence of infectious complications.

Results

Among 522 patients, 121 (23.2%) developed high fever within 3 days after ECMO decannulation. In the overall cohort, 90-day in-hospital mortality did not differ significantly between the high-fever and no-fever groups (19.0% vs. 13.7%, p = 0.372). Multivariable analysis showed no statistically significant association between high fever and mortality (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.55–1.56, p = 0.770). Subgroup analyses revealed opposite associations depending on infection status. High fever was associated with reduced mortality in patients with infection (HR 0.33, 95% CI 0.12–0.89, p = 0.045) but increased mortality in those without (HR 2.25, 95% CI 1.23–4.11, 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 appears to differ depending on the infection status at decannulation, underscoring the importance of carefully assessing infectious complications.