Extracorporeal membrane oxygenation (ECMO) may be considered as rescue therapy in patients with sickle cell disease (SCD) presenting with life-threatening cardiorespiratory failure, particularly acute chest syndrome (ACS). However, outcomes of ECMO in this population remain poorly defined, especially in adult populations. We aimed to synthesize available evidence on mortality and complications associated with ECMO use in adult and pediatric populations with SCD.

We conducted a systematic review and meta-analysis of observational studies reporting ECMO use in patients with confirmed SCD. MEDLINE, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials were searched from January 2000 to January 2025. Risk of bias for included studies was assessed using the ROBINS-I tool. Random-effects meta-analysis of proportions was performed to estimate pooled mortality. Exploratory study-level meta-regression was used to examine associations between mortality and prespecified moderators, including age group, ECMO modality, and ACS as the indication for ECMO.

Seven retrospective studies including 252 patients were included in the meta-analysis. The pooled mortality estimate was 64.5% (95% CI, 39.3–86.0%), with heterogeneity across studies (I² = 80%). Mortality estimates appeared numerically higher in studies including predominantly adult populations, greater use of veno-arterial ECMO, and a higher proportion of patients with ACS at cannulation. Exploratory meta-regression suggested trends toward higher predicted mortality with increasing proportions of adult patients and ACS, and lower mortality with higher proportions of veno-venous ECMO. Reporting of ECMO-related complications was inconsistent, and hemolysis was systematically assessed in only one study.

ECMO use in patients with SCD is associated with high mortality, particularly in severe clinical contexts such as ACS. Substantial heterogeneity and methodological limitations preclude firm conclusions. These findings underscore the need for prospective, disease-specific registries to better define patient selection and management strategies.’