Extracorporeal membrane oxygenation without invasive mechanical ventilation for acute respiratory distress syndrome: an international cohort study
Authors' conclusion
Patients selected for primary awake ECMO and extubated ECMO presented different baseline characteristics, strategy failure, and 90-day mortality rates. However, strategy failure was consistently associated with 90-day mortality in both groups.
Study context
- Population
- Adults with acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO) without invasive mechanical ventilation (IMV), 14 centers in 8 countries (2015–2024)
- Participants
- 307 adults · 14 centers
- Exposure
- Primary awake ECMO vs extubated ECMO
- Primary awake ECMOn = 113
- Extubated ECMOn = 194
- Outcome
- Mortality
- Follow-up
- 90 days after ECMO initiation
Methodological detailsinternational, multicentre
- International
- Multicentre
Main finding
As reported in the abstract
90-day mortality · 90 days
Observational data: associations, not effects.
Further findings
Strategy failure
Association of strategy failure with 90-day mortality (multivariate analysis)
| HR (95% CI) | P value | ||
|---|---|---|---|
| Strategy failure, extubated ECMOMultivariate analysis | 7.67 (3.44–17.11) | P < 0.001 | |
| Strategy failure, primary awake ECMOMultivariate analysis | 5.95 (2.63–13.46) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
- Strategy failure: most frequently within the first 10 days
Other factors associated with 90-day mortality
- Higher age associated with 90-day mortality in extubated ECMO
- Longer time from ICU admission to ECMO cannulation associated with 90-day mortality in primary awake ECMO
Causes of strategy failure
- Leading cause: worsening of respiratory failure; then agitation/delirium in primary awake ECMO and inability to clear secretions in extubated ECMO
Original publication
Extracorporeal membrane oxygenation without invasive mechanical ventilation for acute respiratory distress syndrome: an international cohort study. Am J Respir Crit Care Med. Published 6 May 2026. doi:10.
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