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Early vs Late Initiation of Extracorporeal Membrane Oxygenation: Protocol for a Prospective, Randomized, Multicenter
Alice Bernard1, Helene Haeberle1, Valbona Mirakaj1
1Department of Anaesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany.
JMIR Research Protocols
|June 17, 2026
Summary
The ELIEO trial investigates if early veno-venous extracorporeal membrane oxygenation (vvECMO) improves survival for severe acute respiratory distress syndrome (ARDS) patients compared to rescue therapy. Results will guide optimal vvECMO timing in critical care.
Area of Science:
- Critical Care Medicine
- Respiratory Medicine
- Cardiopulmonary Support
Background:
- Severe acute respiratory distress syndrome (ARDS) causes life-threatening hypoxemia due to lung inflammation.
- Lung-protective ventilation is standard; veno-venous extracorporeal membrane oxygenation (vvECMO) is a rescue therapy.
- Optimal timing for vvECMO initiation in severe ARDS remains uncertain.
Purpose of the Study:
- To determine if early vvECMO initiation improves survival and clinical outcomes in severe ARDS patients.
- To compare early vvECMO against conventional rescue therapy strategies.
Main Methods:
- Prospective, randomized, multicenter trial (ELIEO) enrolling 508 severe ARDS patients.
- Randomization to either early vvECMO (within 24 hours) or conventional management with rescue vvECMO.
- Primary outcome: 90-day all-cause mortality; secondary outcomes include organ function and complications.
Main Results:
- Patient recruitment began March 2025; ongoing with expected completion August 2028.
- As of May 2026, 9 patients recruited; interim analysis planned after 94 enrollments.
- Trial aims to assess if early vvECMO reduces mortality and improves recovery versus rescue therapy.
Conclusions:
- The ELIEO trial will provide crucial evidence on optimal vvECMO timing for severe ARDS.
- Findings may significantly influence clinical decision-making and management strategies for ARDS.
- Results could impact resource allocation in specialized intensive care settings.
