ECMO in Management of Patients With ARDS in The Intensive Care Unit, Systematic Review
Abstract
Purpose: The purpose of this study was to evaluate the efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in comparison to conventional therapy in patients diagnosed with severe acute respiratory distress syndrome (ARDS).
Methods: I carried out a systematic review of randomised controlled trials (RCTs) that were carried out after January 1st 2000, with the purpose of comparing extracorporeal membrane oxygenation (ECMO) to conventional therapy in patients with severe ARDS.
Results: I were able to locate two randomised controlled trials (CESAR and EOLIA), and I merged the data from 429 patients. On day 90, 77 of the 214 patients in the ECMO-group (36%) and 103 of the 215 patients in the control group (48%) had passed away. 36 (17%) of the control patients required emergency cardiopulmonary bypass (ECMO) (35 in EOLIA and 1 in CESAR). The treatment failure at 90 days was defined as death in the ECMO-group and either death or crossover to ECMO in the control group. Patients who were randomly assigned to get ECMO had a greater number of days in which they survived outside of the intensive care unit and were free of respiratory, cardiovascular, renal, and neurological failure. The only meaningful treatment-covariate interaction found in subgroups was a decreased death rate with ECMO in patients who had failure of two organs or less at the time of randomization.
Conclusions: In patients with severely severe ARDS, neither the EOLIA study nor the CESAR study were able to successfully demonstrate that ECMO resulted in a significant improvement in the mortality rate after 60 days.
Description
Since the ECMO was used with ARDS patients, the result was debatable. Moreover, the development of the technology used in ECMO machines changes the effect with time. This study aims to discover the impact of using ECMO with an adult patient who suffers from ARDS compared to the conventional way, like a mechanical ventilator.
Methods:
Criteria for considering studies for this review
Types of studies
This study is a systematic review of randomized controlled trials initiated after January 2000 and in English.
Types of participants
The participants in these trials should be adults over 18 to 60 years old suffering from ARDS, which matches the American-European Consensus Definition or the Berlin definition of ARDS. The participants must be randomly assigned to ECMO therapy or conventional therapy.
Types of interventions
The trial should use ECMO for these patients compared to the conventional way in the control group. The use of ECMO could be in the beginning or shift from traditional treatment such as mechanical ventilator to ECMO.
Types of outcome measures
this study was not considering the outcome of eligibility criteria. However, the survival rate and length of stay in hospital are expected to be essential outcomes. In addition, the quality of life or severity of disability in case there is. Moreover, any other measurable factor that affects the result.
Primary outcomes
The primary outcome was the death rate or survival rate in patients undergoing ECMO compared to the conventional method to treat ARDS.
Secondary outcomes
Secondary outcomes included any measurable signs such as a Physiological state (including disability). Moreover, length of stay in ICU or hospital. Any contraindication that might be related to using ECMO or any treatment procedure.
Search methods for identification of studies
Electronic research is the only way that had been used in this review.
Keywords
ECMO, Extracorporeal Membrane Oxygenation, Clinical Trial, RCT, Acute Respiratory Distress Syndrome, ARDS, Extracorporeal Life Support