The Role of Extracorporeal Membrane Oxygenation in Cardiopulmonary Dysfunction Due to Rheumatologic Diseases: A...

This systematic review documents the current status of extracorporeal membrane oxygenation (ECMO) use in patients with complications of rheumatologic diseases.

Following Preferred Reporting Items for Systematic Reviews and Meta Analyses 2020 guidelines, we conducted a systematic review of studies published from January 2019 to February 2025. Eligible studies included patients with rheumatologic disease complications who received ECMO and had reported outcomes. Exclusion criteria included non-English publications, secondary sources, editorials, and ECMO for nonrheumatologic indications. Searches were performed in February 2025 of four different databases: MEDLINE, Embase+Embase Classic (via Ovid), Scopus, and Web of Science (Core Collection). Data extracted included patient demographics, ECMO indications and details, therapy outcomes, and complications. Descriptive statistics were applied, and risk of bias was assessed using the Newcastle-Ottawa scale.

From 4 different databases, 2,695 records were identified. 144 studies met inclusion criteria, comprising 734 patients. Mean age was 32.2 years (range 7 weeks-70 years), with 340 (46%) females. Common ECMO indications included diffuse alveolar hemorrhage, interstitial lung disease, myocarditis, cardiac arrest, and pulmonary embolism. Leading rheumatologic diagnoses were antineutrophil cytoplasmic antibody-associated vasculitis, inflammatory myositis, systemic lupus erythematosus, antiglomerular basement membrane disease, and antiphospholipid syndrome. ECMO successfully bridged 362 patients to recovery and 54 to transplant; 304 died, and 3 remained on ECMO.

ECMO remains a potential option in life-threatening rheumatologic disease complications. In this review, 416 patients recovered due to ECMO who likely would not have otherwise survived. However, available evidence is largely limited to case reports and small retrospective studies. Limitations include small sample sizes and heterogeneity in reported data.