ECMO For Acute Respiratory Distress Syndrome : Recent Update Including EOLIA Trial
Gee Young Suh1
1Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
The use of ECMO in respiratory failure is one of the most common indication for ECMO. Despite discouraging results of early trials of ECMO in ARDS remained an option in some centers. The use of ECMO for ARDS increased after the 2009 H1N1 influenza pandemic when many previously healthy young people developed respiratory failure due to severe ARDS and many of them survived. The results of CESAR trial which randomized patients to referral to a ECMO center or conventional therapy also gave more enthusiasm for ECMO use. The EOLIA trial was trying to give a definitive answer to the efficacy of vv-ECMO in ARDS patients with refractory hypoxemia. Although the difference in primary outcome did not reach statistical significance, there was a definitive trend for better survival in patients who were randomized to the ECMO group and significant proportion of patients who were randomized to the conventional treatment group had rescue ECMO performed on them and many of these patients survived. Thus in theory we are still lacking the high-quality evidence vv-ECMO for refractory hypoxemia in ARDS patients is here to stay and will become a better option as the technology advances improving benefit-to-risk ratio.