ECMO for severe ARDS: systematic review and individual patient data meta-analysis

Alain Combes, Giles J. Peek, David Hajage, Pollyanna Hardy, Darryl Abrams, Matthieu Schmidt, Agnès Dechartres, Diana Elbourne

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17 Citations (Scopus)

Abstract

PURPOSE: To assess the effect of venovenous extracorporeal membrane oxygenation (ECMO) compared to conventional management in patients with severe acute respiratory distress syndrome (ARDS).

METHODS: We conducted a systematic review and individual patient data meta-analysis of randomised controlled trials (RCTs) performed after Jan 1, 2000 comparing ECMO to conventional management in patients with severe ARDS. The primary outcome was 90-day mortality. Primary analysis was by intent-to-treat.

RESULTS: We identified two RCTs (CESAR and EOLIA) and combined data from 429 patients. On day 90, 77 of the 214 (36%) ECMO-group and 103 of the 215 (48%) control group patients had died (relative risk (RR), 0.75, 95% confidence interval (CI) 0.6-0.94; P = 0.013; I2 = 0%). In the per-protocol and as-treated analyses the RRs were 0.75 (95% CI 0.6-0.94) and 0.86 (95% CI 0.68-1.09), respectively. Rescue ECMO was used for 36 (17%) of the 215 control patients (35 in EOLIA and 1 in CESAR). The RR of 90-day treatment failure, defined as death for the ECMO-group and death or crossover to ECMO for the control group was 0.65 (95% CI 0.52-0.8; I2 = 0%). Patients randomised to ECMO had more days alive out of the ICU and without respiratory, cardiovascular, renal and neurological failure. The only significant treatment-covariate interaction in subgroups was lower mortality with ECMO in patients with two or less organs failing at randomization.

CONCLUSIONS: In this meta-analysis of individual patient data in severe ARDS, 90-day mortality was significantly lowered by ECMO compared with conventional management.

Original languageEnglish
Pages (from-to)2048-2057
Number of pages10
JournalIntensive Care Medicine
Volume46
Issue number11
Early online date6 Oct 2020
DOIs
Publication statusE-pub ahead of print - 6 Oct 2020

Keywords

  • Acute respiratory distress syndrome
  • Adult patients
  • Extracorporeal membrane oxygenation
  • Individual patient data meta-analysis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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