Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

Abstract

Introduction: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a rescue therapy for severe ARDS. This review updates evidence on mortality benefit and complications.
Methods: Literature review (2015–2024) of RCTs and large observational studies comparing VV-ECMO with conventional mechanical ventilation in adults with severe ARDS (PaO₂/FiO₂ <80). Primary outcome: 90-day mortality. Secondary: bleeding, neurological events.
Results: One major RCT (EOLIA) showed 35% mortality with ECMO vs. 46% conventional (p=0.09), but Bayesian reanalysis and meta-analyses of ECMO vs. conventional (6 studies, n=1,112) showed mortality benefit (RR 0.73, p=0.003). Major bleeding occurred in 14% (vs. 8% conventional), intracranial hemorrhage 4%.
Discussion: ECMO likely reduces mortality in severe ARDS when applied early (before multi-organ failure). Bleeding risk is substantial but manageable with modern circuits and anticoagulation protocols.
Conclusions: VV-ECMO is recommended for selected patients with very severe ARDS (P/F <70) failing conventional measures. Centralization in high-volume centers is advised.