|
| | Clinical trial | Study design | Lung protective ventilation in the ECLS group | Lung protective ventilation in the control group | Risk of bias | Outcome |
|
| Randomized clinical trials | Zapol et al. [17] | 90 pts with acute hypoxemic respiratory failure treated with IMV vs. IMV with VA-ECMO | No | No | Low | No improvement with ECMO use, >90% overall mortality |
| Morris et al. [32] | 40 pts with acute hypoxemic respiratory failure treated with IRV IMV vs. IMV with VV-ECCO2R | No | No | Low | No significant difference in mortality, 67% mortality in the ECCO2R group |
| Peek et al. CESAR trial [10] | 180 pts with ARDS treated with IMV vs. IMV with VV-ECMO | Yes | Yes | Low | Significantly reduced mortality (37% vs. 53% in the controls) and disability in the ECMO group |
| Bein et al. Xtravent trial [18] | 79 pts with ARDS treated with ultraprotective lung ventilation by ECCO2R use vs. conventional IMV | Yes | Yes | Low | Favours ECCO2R vs. conventional IMV. More ventilator-free days in pts with P/F ratio <150 |
| Combes et al. EOLIA trial [9] | 249 pts with severe ARDS treated with IMV vs. IMV with VV-ECMO | Yes | Yes | Low | No significant difference in 60-day mortality between the 2 groups |
|
| Observational clinical trials | Lewandowski et al. [16] | Cohort prospective observational study: 73 severe ARDS pts treated with ECMO vs. 49 pts treated with IMV | NA | Yes | High | ECMO was not associated with a lower mortality rate |
| Mols et al. [15] | Cohort prospective observational study: 245 severe ARDS pts, of which 62 treated with ECMO | Yes | Yes | High | ECMO was associated with a lower mortality rate |
| Beiderlinden et al. [14] | Cohort prospective observational study: 150 severe ARDS pts, of which 32 pts treated with ECMO vs. 118 treated with IMV | Yes | N/A | High | Mortality in ECMO pts tended to be higher than that in pts with conservative treatment |
| Noah et al. [11] | Cohort prospective observational study: 75 matched pairs of pts with ARDS due to influenza A (H1N1), treated with VV-ECMO vs. no ECMO therapy | Yes | N/A | Low | ECMO use was associated with lower mortality compared with matched non-ECMO-referred patients |
| ANZ ECMO Influenza Investigators [29] | Retrospective observational study: influenza A (H1N1) ARDS pts, of which 61 were treated with ECMO vs. 133 without ECMO | N/A | N/A | High | ECMO use was associated with higher mortality compared to conservative treatment |
| Roch et al. [13] | Prospective observational study: 18 influenza A (H1N1) ARDS pts, of which 9 were treated with ECMO vs. no ECMO therapy | Yes | Yes | High | ECMO may be an effective salvage treatment in ARDS pts |
| Patroniti et al. [30] | Retrospective observational study: 153 influenza A (H1N1) ARDS pts, of which 60 were treated with ECMO vs. no ECMO therapy | N/A | N/A | High | ECMO may be an effective salvage treatment in ARDS pts |
| Pham et al. [12] | Prospective observational matched case-control study: pts with ARDS due to influenza A (H1N1), treated with VV-ECMO vs. no ECMO therapy | Yes | Yes | Low | ECMO use was associated with no significant difference in mortality compared with matched non-ECMO-referred patients |
| Tsai et al. [28] | Retrospective observational matched case-control study: pts with ARDS, treated with ECMO vs. no ECMO therapy | N/A | Yes | High | ECMO use was associated with lower mortality risk |
| Kanji et al. [27] | Retrospective observational cohort matched and unmatched study: pts with severe hypoxemic respiratory failure, treated with ECMO vs. no ECMO therapy | N/A | N/A | High | ECMO use was associated with lower mortality risk but longer ICU and hospital length of stay |
| Combes et al. SUPERNOVA trial [33] | Prospective single-arm, phase 2 study: 78 of 95 pts received ultraprotective ventilation | Yes | No control group | — | ECCO2R use minimized respiratory acidosis. Relatively high levels of adverse events |
|
| Upcoming clinical trial | REST clinical trial (NCT02654327) | RCT: 1120 pts with acute respiratory failure, with PaO2/FiO2 <150 mmHg | — | — | — | IMV vs. IMV plus ECCO2R |
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