Extracorporeal (external to the body) membrane oxygenation (ECMO) for critically ill adultsReview question: E ect of ECMO on survival in critically ill adults.Background: Extracorporeal membrane oxygenation is a form of life support that targets the heart and lungs. For patients with severe lung failure, ECMO provides extracorporeal gas exchange. For those with severe heart failure or cardiac arrest, ECMO (extracorporeal cardiopulmonary resuscitation (ECPR)) provides gas exchange and systemic blood circulation. Use of ECMO is associated with several risks (e.g. bleeding, clot formation). Study characteristics:We found four studies that randomly allocated 389 patients to receive ECMO versus conventional lung support. All studies comprised patients with acute lung failure. We found no completed study in patients with acute heart failure or arrest. We found one ongoing study in patients with acute lung failure and two ongoing studies in patients with acute heart failure (arrest). The evidence is current to August 2014. Key results: Clinical di erences in the care provided for patients with acute lung failure prevented us from combining the results of individual studies. Individual studies reported no di erences in all-cause death at or before six months in patients given ECMO compared with those who were not. In one study survival was low in both groups but none of the patients who survived had limitations in their daily activities six months a er discharge. Another study found improved survival without severe disability in patients transferred to an ECMO centre for consideration of ECMO six months a er study entry. In three studies, patients in the ECMO group received greater numbers of blood transfusions. One study reported more non-brain bleeding in the ECMO group, and another study reported two serious adverse events in the ECMO group. Another study reported three adverse events in the ECMO group.Quality of the evidence: Clinical practice, study planning and ways of using ECMO have varied considerably among studies. Technological developments (circuits, pumps and mechanical lungs) have improved performance and patient safety with ECMO applications over time. These clinical di erences in the care provided for patients with acute lung failure prevented us from combining the results of individual studies. In critically ill adults, ECMO may or may not be more e ective in improving survival compared with conventional lung support. Results from ongoing studies will help us better understand the role of ECMO and ECPR in the treatment of patients with acute lung or heart failure.

Extracorporeal (external to the body) membrane oxygenation (ECMO) for critically ill adults Review question: E ect of ECMO on survival in critically ill adults. Background: Extracorporeal membrane oxygenation is a form of life support that targets the heart and lungs. For patients with severe lung failure, ECMO provides extracorporeal gas exchange. For those with severe heart failure or cardiac arrest, ECMO (extracorporeal cardiopulmonary resuscitation (ECPR)) provides gas exchange and systemic blood circulation. Use of ECMO is associated with several risks (e.g. bleeding, clot formation). Study characteristics: We found four studies that randomly allocated 389 patients to receive ECMO versus conventional lung support. All studies comprised patients with acute lung failure. We found no completed study in patients with acute heart failure or arrest. We found one ongoing study in patients with acute lung failure and two ongoing studies in patients with acute heart failure (arrest). The evidence is current to August 2014. Key results: Clinical di erences in the care provided for patients with acute lung failure prevented us from combining the results of individual studies. Individual studies reported no di erences in all-cause death at or before six months in patients given ECMO compared with those who were not. In one study survival was low in both groups but none of the patients who survived had limitations in their daily activities six months a er discharge. Another study found improved survival without severe disability in patients transferred to an ECMO centre for consideration of ECMO six months a er study entry. In three studies, patients in the ECMO group received greater numbers of blood transfusions. One study reported more non-brain bleeding in the ECMO group, and another study reported two serious adverse events in the ECMO group. Another study reported three adverse events in the ECMO group. Quality of the evidence: Clinical practice, study planning and ways of using ECMO have varied considerably among studies. Technological developments (circuits, pumps and mechanical lungs) have improved performance and patient safety with ECMO applications over time. These clinical di erences in the care provided for patients with acute lung failure prevented us from combining the results of individual studies. In critically ill adults, ECMO may or may not be more e ective in improving survival compared with conventional lung support. Results from ongoing studies will help us better understand the role of ECMO and ECPR in the treatment of patients with acute lung or heart failure.

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