ECMO for ARDS: from salvage to standard of care?

The EOLIA randomised controlled trial, 1 Combes A Hajage D Capellier G et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018; 378: 1965-1975 Crossref PubMed Scopus (1088) Google Scholar which was published in 2018, did not show a significant difference in its prespecified primary endpoint of 60-day mortality between the extracorporeal membrane oxygenation (ECMO) group and the control group, who received conventional mechanical ventilation. However, the large and clinically important effect size noted in the trial, 2 Harrington D Drazen JM Learning from a trial stopped by a data and safety monitoring board. N Engl J Med. 2018; 378: 2031-2032 Crossref PubMed Scopus (28) Google Scholar a post-hoc Bayesian analysis 3 Goligher EC Tomlinson G Hajage D et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc Bayesian analysis of a randomized clinical trial. JAMA. 2018; 320: 2251-2259 Crossref PubMed Scopus (249) Google Scholar of EOLIA data showing a high likelihood of survival benefit with ECMO even assuming a strongly sceptical prior distribution, and now a meta-analysis 4 Munshi L Walkey A Goligher E Pham T Uleryk E Fan E Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med. 2019; (published online Jan 11.)http://dx.doi.org/10.1016/S2213-2600(18)30452-1 Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar published in The Lancet Respiratory Medicine by Laveena Munshi and colleagues, all suggest that ECMO is efficacious in some adult patients with severe acute respiratory distress syndrome (ARDS). Correction to Lancet Respir Med 2019; 7: 108–10Abrams D, Ferguson ND, Brochard L, et al. ECMO for ARDS: from salvage to standard of care? Lancet Respir Med 2019; 7: 108–10—In the figure of this Comment, the final point in the box beginning “Are any of the following criteria met?” should have read “pH <7·25 with PaCO2 ≥60 mm Hg for >6 h*”. This change has been made to the online version as of Jan 29, 2019, and the printed version is correct. Full-Text PDF