ARDS · Extracorporeal support
Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome
| Design | Randomised controlled trial, stopped early for futility |
|---|---|
| Treatment | Immediate veno-venous ECMO |
| Control | Conventional mechanical ventilation with ECMO available as rescue |
| Population | 249 patients with very severe ARDS |
| Follow-up | 60 days |
| Primary endpoint | Death at 60 days |
| Result | Death at 60 days in 44 of 124 (35%) with ECMO versus 57 of 125 (46%) with conventional ventilation — relative risk 0.76 (95% CI 0.55 to 1.04, p=0.09). Crossover to rescue ECMO occurred in 35 control patients (28%) a mean of 6.5 days after randomisation, and 20 of those (57%) died. Bleeding events requiring transfusion were more frequent with ECMO. |
| Secondary endpoints | Treatment failure, ventilator-free days, bleeding, stroke |
Among patients with very severe ARDS, 60-day mortality was not significantly lower with ECMO than with a strategy of conventional mechanical ventilation that included ECMO as rescue therapy.
The trial authors, in the published abstract
A negative trial that is widely read as supporting ECMO, and the reason is the 28% crossover: the control arm was not really 'no ECMO' but 'ECMO later if needed', and 57% of those crossing over died. It tests timing, not the therapy. CESAR asked a related question about referral to an ECMO centre.
Combes A, Hajage D, Capellier G, et al. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. N Engl J Med 2018 May 24;378(21):1965-1975.