A randomized study sought to answer the continuing debate over the utility of early extracorporeal membrane oxygenation for very severe ARDS.
“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“.
Bleeding and thrombocytopenia were higher in the ECMO group and ischemic stroke less.
There was a clear trend to better mortality but not clinically significant, and the trial was stopped early for futility. Experts question the statistical design and cutoff point for futility. There was also a sizeable crossover to rescue ECMO in the control conventional ventilation group. The debate is unlikely to end, and ECMO will probably remain in the armamentarium of severe ARDS treatment in expert centers as a viable choice.