Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis
Abstract
Background Use of extracorporeal membrane oxygenation (ECMO) in adults with severe acute respiratory distress syndrome has increased in the past 10 years. However, the efficacy of venovenous ECMO in people with acute respiratory distress syndrome is uncertain according to the most recent data. We aimed to estimate the effect of venovenous ECMO on mortality from acute respiratory distress syndrome.Methods In this systematic review and meta-analysis, we searched MEDLINE (including MEDLINE In-Process and Epub Ahead of Print), Embase and the Wiley search platform in the Cochrane database for randomised controlled trials and observational studies with matching of conventional mechanical ventilation with and without venovenous ECMO in adults with acute respiratory distress syndrome. Titles, abstracts, and full-text articles were screened in duplicate by two investigators. Data for study design, patient characteristics, interventions, and study outcomes were abstracted independently and in duplicate. Studies were weighted with the inverse variance method and data were pooled via random-effects modelling. We calculated risk ratios (RRs) and 95% CIs to summarise results. The primary outcome was 60-day mortality across randomised controlled trials. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines were used to rate the quality of evidence FINDINGS: We included five studies, two randomised controlled trials and three observational studies with matching techniques (total N=773 patients). In the primary analysis, which included two randomised controlled trials with a total population of 429 patients, 60-day mortality was significantly lower in the venovenous ECMO group than in the control group (73 [34%] of 214 vs 101 [47%] of 215; RR 0·73 [95% CI 0·58-0·92]; p=0·008; I 2 0%). The GRADE level of evidence for this outcome was moderate. Three studies included data for the incidence of major haemorrhage in the ECMO group. 48 (19%) of the 251 patients in these three studies had major haemorrhages.Interpretation Compared with conventional mechanical ventilation, use of venovenous ECMO in adults with severe acute respiratory distress syndrome was associated with reduced 60-day mortality. However, venovenous ECMO was also associated with a moderate risk of major bleeding. These findings have important implications surrounding decision making for management of severe acute respiratory distress syndrome at centres providing venovenous ECMO.Funding None.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
However, one recent systematic review found that VV ECMO delivered at expert centers reduced mortality for patients with severe ARDS.
“However, one recent systematic review found that VV ECMO delivered at expert centers reduced mortality for patients with severe ARDS [475].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [475]
Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is used in patients with severe acute respiratory failure to facilitate gas exchange in the setting of refractory hypoxaemia or hypercapnic respiratory acidosis.
“Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is used in patients with severe acute respiratory failure to facilitate gas exchange in the setting of refractory hypoxaemia or hypercapnic respiratory acidosis [475].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [475]
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
(2014) · Medical Entomology and Zoology · Cited by 17,633 · see citing works
GRADE guidelines: 3. Rating the quality of evidence
Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., Vist, G. E., Falck-Ytter, Y., Meerpohl, J., & Norris, S. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.015 · Cited by 8,285 · see citing works
Peek, G. J., Mugford, M., Tiruvoipati, R., Wilson, A., Allen, E., Thalanany, M. M., Hibbert, C. L., Truesdale, A., Clemens, F., Cooper, N., et al. (2009) · The Lancet · doi:10.1016/s0140-6736(09)61069-2 · Cited by 3,395 · see citing works
Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome
Combes, A., Hajage, D., Capellier, G., Demoule, A., Lavoué, S., Guervilly, C., Da Silva, D., Zafrani, L., Tirot, P., Veber, B., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1800385 · Cited by 2,380 · see citing works
Self-citationFan, E., Sorbo, L. D., Goligher, E. C., Hodgson, C. L., Munshi, L., Walkey, A. J., Adhikari, N. K. J., Amato, M. B. P., Branson, R. D., Brower, R. G., et al. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201703-0548st · Cited by 1,647 · see citing works
Self-citationExtracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome
The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators* (2009) · JAMA · doi:10.1001/jama.2009.1535 · Cited by 1,585 · see citing works
Noah, M. A., Peek, G. J., Finney, S. J., Griffiths, M., Harrison, D. A., Grieve, R., Sadique, Z., Sekhon, J. S., McAuley, D. F., Firmin, R. K., et al. (2011) · JAMA · doi:10.1001/jama.2011.1471 · Cited by 832 · see citing works
Barbaro, R. P., Odetola, F. O., Kidwell, K., Paden, M. L., Bartlett, R. H., Davis, M. M., & Annich, G. M. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201409-1634oc · Cited by 752 · see citing works
Pham, T. O., Combes, A., Rozé, H., Chevret, S., Mercat, A., Roch, A., Mourvillier, B., Ara-Somohano, C., Bastien, O. H., Zogheib, E. H., et al. (2012) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201205-0815oc · Cited by 496 · see citing works
Self-citationPatroniti, N. A., Zangrillo, A., Pappalardo, F., Peris, A., Cianchi, G., Braschi, A., Iotti, G. A., Arcadipane, A. F., Panarello, G., Ranieri, V. M., et al. (2011) · Intensive Care Medicine · doi:10.1007/s00134-011-2301-6 · Cited by 359 · see citing works
Schmidt, M., Stewart, C. E., Bailey, M., Nieszkowska, A., Kelly, J., Murphy, L., Pilcher, D. V., Cooper, D. J., Scheinkestel, C. D., Pellegrino, V. A., et al. (2015) · Critical Care Medicine · doi:10.1097/ccm.0000000000000753 · Cited by 244 · see citing works
Extracorporeal membrane oxygenation for critically ill adults
Tramm, R., Ilić, D., Davies, A. R., Pellegrino, V. A., Romero, L., & Hodgson, C. L. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010381.pub2 · Cited by 175 · see citing works
Mechanical ventilation during extracorporeal life support (ECLS): a systematic review
Marhong, J. D., Munshi, L., Detsky, M. E., Telesnicki, T., & Fan, E. (2015) · Intensive Care Medicine · doi:10.1007/s00134-015-3716-2 · Cited by 97 · see citing works
Self-citationFitzgerald, M., Millar, J. E., Blackwood, B., Davies, A., Brett, S. J., McAuley, D. F., & McNamee, J. J. (2014) · Critical Care · doi:10.1186/cc13875 · Cited by 90 · see citing works
Zampieri, F. G., Mendes, P. V., Ranzani, O., Taniguchi, L. U., Azevedo, L. C. P., Costa, E. L. V., & Park, M. (2013) · Journal of Critical Care · doi:10.1016/j.jcrc.2013.07.047 · Cited by 70 · see citing works
Use of ECMO in ARDS: does the EOLIA trial really help?
Gattinoni, L., Vasques, F., & Quintel, M. (2018) · Critical Care · doi:10.1186/s13054-018-2098-6 · Cited by 70 · see citing works
Will CESAR answer the adult ECMO debate?
Zwischenberger, J. B., & Lynch, J. E. (2009) · The Lancet · doi:10.1016/s0140-6736(09)61630-5 · Cited by 69 · see citing works
Extracorporeal Life Support for Acute Respiratory Failure. A Systematic Review and Metaanalysis
Munshi, L., Telesnicki, T., Walkey, A. J., & Fan, E. (2014) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201401-012oc · Cited by 56 · see citing works
Self-citationTsai, H.-C., Chang, C., Tsai, F., Fan, P., Juan, K.-C., Lin, C., Yang, H., Kao, K., Fang, J., Yang, C., et al. (2015) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2015.03.092 · Cited by 38 · see citing works
Munshi, L., Gershengorn, H. B., Fan, E., Wunsch, H., Ferguson, N. D., Stukel, T. A., & Rubenfeld, G. D. (2016) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201606-438oc · Cited by 23 · see citing works
Self-citationVentilatory support versus ECMO for severe adult respiratory failure
Jones, A., Barrett, N. A., Scales, D. C., & Beale, R. J. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60223-1 · Cited by 13 · see citing works
Ventilatory support versus ECMO for severe adult respiratory failure
Jainandunsing, J. S., & Ismael, F. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60221-8 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Alhazzani, W., Møller, M. H., Arabi, Y. M., Loeb, M., Gong, M. N., Fan, E., Oczkowski, S., Levy, M. M., Derde, L., Dzierba, A., et al. (2020) · Intensive Care Medicine · doi:10.1007/s00134-020-06022-5 · Cited by 2,105 · see citing works
Self-citationSurviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
21st Century critical care medicine: an overview
Padte, S., Samala Venkata, V., Mehta, P., Tawfeeq, S., Kashyap, R., & Surani, S. (2024) · World Journal of Critical Care Medicine · doi:10.5492/wjccm.v13.i1.90176 · Cited by 26 · see citing works
- Authors
- Munshi, L., Walkey, A., Goligher, E., Pham, T., Uleryk, E. M., & Fan, E.
- Affiliations
- University Health Network (CA)
- Boston University (US)
- Corresponding author
- Munshi, Laveena
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 7
- Issue
- 2
- Pages
- 163-172
- ISSN
- 2213-2600 (ISSN-L)
- OpenAlex
- W2911047707
- Cited by
- 398
- References
- 25
- Citations by year
- 2026: 24 · 2025: 38 · 2024: 53 · 2023: 57 · 2022: 53 · 2021: 87 · 2020: 69 · 2019: 17
- FWCI
- 9.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- veno-venous extracorporeal membrane oxygenation, acute respiratory distress syndrome, 60-day mortality, major bleeding, mechanical ventilation, severe respiratory failure, treatment decision-making, quality of evidence grading, GRADE, risk of bias assessment, heterogeneity of evidence
- MeSH terms
- Adult, Cause of Death, Female, Humans, Male, Middle Aged, Reference Values, Respiration, Artificial, Respiratory Distress Syndrome, Severity of Illness Index, Extracorporeal Membrane Oxygenation, Survival Analysis, Randomized Controlled Trials as Topic, Treatment Outcome, Hospital Mortality, Risk Assessment, Observational Studies as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
