Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-analysis.

To determine if immunocompromised (IC) status correlates with higher hospital mortality in acute respiratory distress syndrome (ARDS) patients on extracorporeal membrane oxygenation (ECMO) and the impact of IC type on outcomes. On February 10, 2026, searches were conducted in PubMed, Embase, Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP). Eligible English full-text cohort studies of adults meeting the 2012 Berlin ARDS criteria, including IC versus immunocompetent (ICM) studies and IC-only studies. Study quality was assessed using the Newcastle-Ottawa Scale. Outcomes included primary (hospital mortality) and secondary (ECMO weaning rate, 6 month mortality). Analyses were performed with RevMan/R 4.4.2; risk ratio (RR)/odds ratio (OR) for effect sizes, and Cochrane Q test/ I2 for heterogeneity. Seventeen studies (17 retrospective, 2 prospective; 12 IC vs. ICM, 7 IC-only) involving 5,136 patients (1,311 IC, 3,825 ICM) were included. Immunocompromised patients had a lower ECMO weaning rate (RR = 0.77), higher hospital mortality (RR = 1.38), and higher 6 month mortality (RR = 1.31). Subgroup analysis showed: high risk (hematological malignancies, OR = 3.76), moderate risk (autoimmune diseases, OR = 2.50), low risk (solid organ transplantation, OR = 1.40). No significant publication bias. Immunocompromised patients are an independent risk factor for poor ECMO outcomes in ARDS. Outcomes differ by IC type; ECMO may be considered for selected IC patients, especially low-risk subgroups.