Mortality after ECMO for patients with COVID-19 worsened during 2020. These findings inform the role of extracorporeal membrane oxygenation (ECMO) in COVID-19 for patients, clinicians, and policy makers.

In 2020, 4,812 patients with COVID-19 received ECMO across 349 centres within 41 countries.

For early-adopting centres, the cumulative incidence of in-hospital mortality 90 days after ECMO initiation was 36·9% in patients who started ECMO on or before May 1 (group A1) versus 51·9% after May 1 (group A2); at late-adopting centres (group B), it was 58·9%.

Relative to patients in group A2, group A1 patients had a lower adjusted relative risk of in-hospital mortality 90 days after ECMO, whereas group B patients had a higher adjusted relative risk.

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