What are the benefits of using extracorporeal membrane oxygenation (ECMO) in the treatment of acute respiratory distress syndrome (ARDS)?

Updated: Mar 27, 2020
  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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A large multicenter trial in the 1970s demonstrated that extracorporeal membrane oxygenation (ECMO) did not improve the mortality rate in ARDS patients. A later trial using extracorporeal carbon dioxide removal along with inverse-ratio ventilation also did not improve survival in ARDS. [51] However, during the H1N1 flu epidemic in 2009, ECMO appeared to improve survival in patients with H1N1-associated ARDS who could not be oxygenated with conventional mechanical ventilation. [52] This led to a 2018 study of venovenous ECMO for ARDS. [53] In this study, patients with very severe ARDS (PaO2/FiO2 of < 50) were randomized to venovenous ECMO or conventional management with ECMO rescue for refractory hypoxemia. Although there was a trend toward lower mortality (35% EMCO vs 46% control), there was no statistically significant difference in 60-day mortality. Extracorporeal carbon dioxide removal may also be an option for ARDS. Extracorporeal carbon dioxide removal uses a less invasive system than venovenous ECMO, similar to hemodialysis. Carbon dioxide removal would allow lower-intensity mechanical ventilation and possibly less ventilator-associated lung injury. This is currently under study.

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