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This study aimed to investigate trends in extracorporeal membrane oxygenation (ECMO) treatment during 2005-2018 and examine factors associated with in-hospital mortality. We conducted a population-based cohort study based on health records obtained from the National Health Insurance Service database in South Korea. All adult patients (⩾18 years old) who received ECMO treatment in the intensive care unit after hospitalization from 2005 to 2018 were enrolled. We analyzed data for 21,129 adult ECMO patients from 128 hospitals. The prevalen