- Design
- Systematic review and random-effects meta-analysis
- Population
- 163 studies, 78,053 adults treated with ECMO
- Primary outcome
- All-cause mortality and function at 6 months or later
- Effect
- 1-year mortality VV 37.2%, VA 55.2%, ECPR 74.4%
A systematic review and meta-analysis in Critical Care Medicine (August 2026) pooled 163 randomised and observational studies of 78,053 adults treated with extracorporeal membrane oxygenation, with outcomes at six months or later.
One-year mortality was 37.2% (95% CI 30.0% to 45.1%) after venovenous ECMO, 55.2% (50.2% to 60.1%) after venoarterial ECMO and 74.4% (71.4% to 77.2%) after extracorporeal cardiopulmonary resuscitation (ECPR). Functional outcomes were reported in only 38 studies (23%), using varied instruments, mostly the Cerebral Performance Category.
Most data are observational, selection criteria differ widely between centres, and many studies did not report one-year outcomes. The numbers are benchmarks, not predictions for an individual.
They are useful for the conversation with families in the emergency department and ICU, where ECMO is often discussed before it is started.
- Use modality-specific one-year mortality figures when discussing ECMO with families
- Expect about three-quarters mortality at one year after ECPR
- Recognise that survival data say little about function — only a quarter of studies reported it
- Refer early to an ECMO centre when venovenous ECMO for respiratory failure is being considered
Why it matters
Families are usually told about survival to discharge; this gives the one-year picture, which is often what they want to know.
Don't overread it
These are pooled observational estimates from selected patients; they do not predict individual outcomes.
The statistics, in plain English
The confidence intervals are the range within which the true average mortality probably lies; for venovenous ECMO it is wide (30% to 45%) because fewer studies reported one-year outcomes. They describe patients who were selected for ECMO, not all patients who might be considered.
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