Comparison of venovenous extracorporeal membrane oxygenation, prone position and supine mechanical ventilation for severely hypoxemic acute respiratory distress syndrome: a network meta-analysis
Authors' conclusion
In adults with ARDS and severe hypoxia, both VV-ECMO (low to moderate certainty evidence) and prone ventilation (moderate to high certainty evidence) improve mortality relative to low and moderate Vt strategies. The impact of VV-ECMO versus prone ventilation remains uncertain.
Study context
- Population
- Severe acute respiratory distress syndrome (ARDS) meeting eligibility criteria for ventilation, and venovenous extracorporeal membrane oxygenation (VV-ECMO) or with PaO2/FiO2 < 80 mmHg
- Participants
- 812 participants · 10 randomised controlled trials (RCTs)
- Comparison
- VV-ECMO vs prone ventilation vs low Vt vs moderate Vt
- Outcome
- Mortality
Methodological detailsfrequentist, Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology
- Frequentist
- GRADE methodology
Pooled result
As reported in the abstract
Relative risk (95% CI)
VV-ECMO vs Low Vtmoderate certainty
0.77(0.59–0.99)
VV-ECMO vs Moderate Vtlow certainty
0.75(0.57–0.98)
Prone ventilation vs Moderate Vthigh certainty
0.78(0.66–0.93)
Prone ventilation vs Low Vtmoderate certainty
0.81(0.63–1.02)
VV-ECMO vs Prone ventilationsolely indirect comparisons, very low certainty
0.95(0.72–1.26)
Original publication
Comparison of venovenous extracorporeal membrane oxygenation, prone position and supine mechanical ventilation for severely hypoxemic acute respiratory distress syndrome: a network meta-analysis. Intensive Care Med. Published 6 June 2024. doi:10.
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