Extracorporeal membrane oxygenation for critically ill adults

Area of Science:

• Critical Care Medicine
• Cardiopulmonary Support
• Systematic Review

Background:

• Extracorporeal membrane oxygenation (ECMO) is a life support targeting heart and lungs, with established use in neonates but uncertain effectiveness in adults.
• ECMO configurations vary, and its use carries risks like hemorrhage and ischemia.
• While effective for neonates, adult ECMO's clinical efficacy for respiratory or cardiac failure remains unclear.

Purpose of the Study:

• To determine if veno-venous (VV) or venous-arterial (VA) ECMO in adults improves survival compared to conventional support.
• To systematically review randomized controlled trials (RCTs) comparing adult ECMO with conventional therapies.

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, EMBASE) and ongoing trial registries up to August 2014.
• Included RCTs, quasi-RCTs, and cluster-RCTs comparing adult ECMO with conventional support.
• Two independent reviewers screened citations, reviewed full texts, assessed risk of bias, and extracted data.

Main Results:

• Four RCTs involving 389 participants with acute respiratory failure were included; risk of bias was low in three.
• No statistically significant differences in all-cause mortality at six months or earlier were found between ECMO and conventional support.
• Evidence quality was low to moderate; clinical heterogeneity prevented meta-analysis. No RCTs on cardiac failure/arrest were completed, but ongoing trials exist.

Conclusions:

• ECMO is considered a rescue therapy, but adult effectiveness for respiratory failure remains inconclusive based on limited RCT data.
• Significant changes in ECMO technology and treatment since 2000 necessitate updated research.
• Results from ongoing RCTs are crucial for defining the role of ECMO and extracorporeal cardiopulmonary resuscitation (ECPR) in adult cardiac failure or arrest.