Reviews of VV and VA ECMO:
Fan E, Gattinoni L, Combes A, et al. Venovenous extracorporeal membrane oxygenation for acute respiratory failure : A clinical review from an international group of experts. Intensive Care Med. 2016; 42:712-724. This concise review nicely summarizes the physiology of VV ECMO as well as the indications, technical aspects of cannulation, complications, and supportive aspects of care including mechanical ventilation, anticoagulation, and blood transfusion.
PMID: 27007108
Keebler ME, Haddad EV, Choi CW, et al. Venoarterial extracorporeal membrane oxygenation in cardiogenic shock. JACC Heart Fail. 2018; 6:503-516. This review provides a useful introduction to available VA ECMO configurations as well as key aspects of patient management including targeting support goals, monitoring for complications, and weaning from ECMO.
PMID: 29655828
ECMO for ARDS:
Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374:1351-63. Highlighting both regionalization of care and use of ECMO, this trial showed that transfer to an ECMO-ready facility (75% of those transferred actually received ECMO) led to an NNT of 6 to prevent one death or severe disability at six months compared to standard care. The study was limited by the lack of a mandated lung-protective strategy in the control group; 93% of those transferred for possible ECMO received a lung-protective strategy, compared to 70% in the control group.
PMID: 19762075
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Combes A, Hajage D, Capellier G et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018; 378:1965-1975. The multicenter EOLIA randomized 249 patients with very severe ARDS to immediate VV ECMO vs standard care. 60-day mortality was lower in the ECMO group but the difference was not statistically significant (35% vs. 46%, p value 0.09). The study was stopped early for futility despite a trend toward benefit. Of note, 28% of control patients crossed over to ECMO due to refractory hypoxemia, with 43% of this group surviving.
PMID: 29791822
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***For additional information, see ARDS section
ECMO in Sepsis:
Brechot N, Hajage D, Kimmoun A, et al. Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: A retrospective, multicentre, international cohort study. Lancet. 2020;396(10250):545-552. This study of 82 patients compared VA-ECMO to usual care, and found patients treated with VA-ECMO had a significantly higher 90-day survival (60% vs 25%, RR for mortality 0.54, 95% CI [0.40-0.70]).
PMID: 32828186
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