Use of ECMO in ARDS: does the EOLIA trial really help?

Excerpt

Since 1979, four randomized trials have studied the effectiveness of extracorporeal membrane oxygenation (ECMO) in respiratory failure. Zapol et al. found no difference between patients treated with mechanical ventilation (MV) alone and patients treated with MV plus ECMO [1]. The groups differed with regard to the use of ECMO and FiO₂, without changing the mechanical ventilation variables. Fifteen years later, Morris et al. compared conventional MV, and low frequency MV combined with mid-flow extracorporeal CO₂ removal [2]. Both studies suffered from technical difficulties. The technology was fairly primitive then, but has since steadily improved. Peek et al. (CESAR trial) studied patients with severe respiratory failure treated either with MV plus ECMO in a specialized center or with conventional MV in peripheral hospitals [3]. The combined primary outcome parameter, mortality or severe disability after 6 months, was better in the ECMO group. However, of the 90 patients assigned to ECMO only 68 were actually connected, and the study design itself raised concerns about the robustness of the conclusions [3]. …