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Updated: Jul 15, 2025
03:40
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
340
Extracorporeal membrane oxygenation for critically ill adults
Aidan Burrell1,2, Jiwon Kim1, Patricia Alliegro1
1Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
The Cochrane Database of Systematic Reviews
|September 26, 2023
Summary
Extracorporeal membrane oxygenation (ECMO) reduces mortality in critically ill adults but increases bleeding risk. Evidence quality is low to moderate, necessitating further research for optimal ECMO use in severe cardiac or respiratory failure.
Area of Science:
- Critical Care Medicine
- Cardiopulmonary Support
- Systematic Review and Meta-Analysis
Background:
- Extracorporeal membrane oxygenation (ECMO) offers potential benefits for severe cardiac/respiratory failure and cardiac arrest.
- High-quality evidence guiding ECMO practice is limited, despite its associated risks.
- An updated systematic review was conducted following recent large randomized controlled trials (RCTs).
Approach:
- Systematic review and meta-analysis of RCTs, quasi-RCTs, and cluster-RCTs comparing ECMO (VV, VA, ECPR) to conventional support.
- Searched Cochrane databases up to March 2022, limited to English language.
- Assessed mortality (90-day to 1-year), survival, disability, adverse events, quality of life, and cost-effectiveness using GRADE.
Key Points:
- Five RCTs (757 participants) were included; four new studies updated the previous review.
- ECMO significantly reduced 90-day to 1-year all-cause mortality (RR 0.80; 95% CI 0.70-0.92).
- ECMO use was associated with a threefold increased risk of major hemorrhage (RR 3.32; 95% CI 1.90-5.82).
Conclusions:
- Updated systematic review indicates ECMO reduces mortality in critically ill adults.
- However, the certainty of evidence is low to moderate, limited by small trial numbers and heterogeneity.
- Increased bleeding risk with ECMO requires careful consideration in clinical decision-making.
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