- Design
- Systematic review and random-effects meta-analysis
- Population
- 163 studies, 78,053 adults treated with ECMO
- Primary outcome
- All-cause mortality at or beyond 6 months
- Effect
- 1-year mortality VV 37.2% (30.0 to 45.1); VA 55.2% (50.2 to 60.1); ECPR 74.4% (71.4 to 77.2)
A systematic review of 163 randomised and observational studies (78,053 adults) pooled long-term outcomes after extracorporeal membrane oxygenation (ECMO), with 156 studies contributing to mortality estimates.
One-year mortality was 37.2% after venovenous ECMO, 55.2% after venoarterial ECMO and 74.4% after extracorporeal cardiopulmonary resuscitation (ECPR). Functional outcomes were reported in only 38 studies, using varied scales, so the authors could not pool them.
These are the numbers families ask for, and they differ sharply by indication. For emergency physicians and intensivists referring to an ECMO centre, they give a realistic starting point for the conversation. What they cannot yet give is the quality of survival, which remains largely unmeasured.
- Quote modality-specific one-year survival when discussing ECMO with families
- For ECPR, be clear that most patients do not survive a year
- Ask the ECMO centre for its own outcome data where available
- Plan follow-up of function and cognition in survivors
Why it matters
Families are often given short-term survival figures that overstate how many patients are alive a year later.
Don't overread it
Mostly observational, heterogeneous centres and selected patients; these are benchmarks, not predictions for an individual.
The statistics, in plain English
A pooled proportion of 74.4% (95% CI 71.4% to 77.2%) for ECPR is precise because many studies agreed. The venovenous interval is wider (30.0% to 45.1%), reflecting more variation between centres and indications. Survivors who were not followed up can bias mortality estimates either way.
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