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The following is a summary of “Fluid management in adult patients undergoing venoarterial extracorporeal membrane oxygenation: A scoping review,” published in the April 2025 issue of Journal of Critical Care by Jendoubi et al. 

The utilization of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiocirculatory support in patients with critical illness had significantly increased, yet the ideal fluid resuscitation approach remained a subject of debate despite fluid therapy’s crucial role in hemodynamic management.  

Researchers conducted a retrospective study to map existing knowledge on fluid management in VA-ECMO, focusing on fluid type, dosing, and the impact of fluid balance on outcomes.  

They searched the literature in PubMed and EMBASE from the database inception to April 2024. Studies involving adults with critical illness on VA-ECMO, regardless of indication (cardiogenic shock or extracorporeal cardiopulmonary resuscitation), with or without renal replacement therapy, were included. Studies had to describe fluid resuscitation strategies, focus on fluid type, or report the impact of fluid balance on clinical outcomes and mortality. Extracted data included the study population, ECMO indications, fluid types, resuscitation strategies, fluid balance, and outcome measures.  

The results showed that 16 studies met the inclusion criteria. No studies compared restrictive vs liberal fluid approaches or assessed the efficacy and safety of balanced vs saline solutions. The role of albumin as an alternative fluid requires further investigation. Despite study heterogeneity, both early and cumulative fluid overload negatively impacted survival and renal outcomes.  

Investigators concluded that the existing literature regarding fluid management during VA-ECMO was limited, emphasizing the necessity for more potent evidence concerning optimal fluid dosing, type, and resuscitation targets to standardize practice and enhance patient outcomes. 

Source: sciencedirect.com/science/article/pii/S0883944124004945