The following is a summary of “Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review,” published in the August 2023 issue of Critical Care by Belletti et al.

Researchers started a retrospective study to assess the efficacy and safety of awake Extracorporeal membrane oxygenation (ECMO) without invasive ventilation in patients with respiratory failure. PubMed, Web of Science, and Scopus were searched for studies on awake ECMO outcomes in adults with respiratory failure.

They reviewed all studies (including those reporting outcomes of awake ECMO in patients with respiratory failure) and excluded studies related to ECMO for cardiovascular failure, cardiac arrest, perioperative support, and pediatric patients. Two investigators screened and selected the studies independently. Data on study details, awake ECMO failure rate, and mortality were abstracted by two investigators. The main outcome was the rate of sharp ECMO failure (requiring intubation). Pooled estimates with 95% CI were calculated and stratified by setting.

The results showed 467 awake ECMO patients across 57 studies (including 28 case reports). The pooled estimate for awake ECMO failure in patients with acute respiratory distress syndrome was 39.3% (95% CI, 24.0–54.7%). In patients bridged to lung transplantation, the pooled estimate for awake ECMO failure was 23.4% (95% CI, 13.3–33.5%). The longest follow-up mortality rate was 28% (121 out of 439; 95% CI, 22.3–33.6%). The mortality rate for patients who failed the awake ECMO strategy was 57.2% (43 out of 74; 95% CI, 40.2–74.3%). Two cases of cannula self-removal were reported.

They concluded awake ECMO was feasible in selected patients, but its impact on mortality remains unclear.

Source: journals.lww.com/ccmjournal/abstract/9900/extracorporeal_membrane_oxygenation_without.197.aspx