Background: Severe burn injuries, particularly when complicated by inhalation injury and acute respiratory distress syndrome (ARDS), remain among the most challenging clinical scenarios in critical care. Conventional treatment often yields mortality rates as high as 80%. This study evaluates the efficacy of Extracorporeal Membrane Oxygenation (ECMO) as a salvage therapy by nationwide longitudinal data and our institution’s clinical experience.

Methods: We analyzed a 16-year nationwide cohort from the Taiwan National Health Insurance Research Database (NHIRD) and compared these findings with a focused clinical report from our institution involving patients with extreme total body surface area (TBSA) burns.

Results: National data indicate that ECMO recipients face high in-hospital mortality rates (47.09% to 54.41%), reflecting the extreme physiological injury of these patients. However, our institutional data revealed a significant deviation from these trends. In a cohort with a median TBSA of 94.5% and a revised Baux score of 139—where predicted mortality was nearly 90%—ECMO achieved a survival rate of 42.8%. While early-phase mortality remains challenging, long-term survival curves for those who survived the initial crisis remained stable. Key predictors of mortality included age ≥65, TBSA ≥30%, and high serum lactate levels (>8 mmol/L).

Conclusion: While nationwide statistics highlight the risks and high mortality associated with severe burns requiring ECMO, our institutional success demonstrates that ECMO is not in vain. It serves as an essential "life-saving bridge" for patients with refractory hypoxemia who fail conventional ventilation. These findings suggest that with patient selection and multidisciplinary care, ECMO can significantly improve survival outcomes even in cases previously considered "unsurvivable."

Jiun-Yu Lin earned his medical degree from the National Defense Medical University, Taiwan and completed his clinical and specialize training in cardiovascular surgery at Tri-Service General Hospital, an institution recognized as a premier center for trauma surgery and cardiopulmonary critical care in Taipei. His primary research focuses on mechanical circulatory support, in which he has published numerous research articles. Dr. Lin’s work is dedicated to optimizing salvage therapies like ECMO or VAD for critically ill patients, integrating clinical experience with evidence-based research to improve survival in critical cardiovascular cases.