Extracorporeal membrane oxygenation without invasive mechanical ventilation for acute respiratory distress syndrome: an international cohort study
RATIONALE: In acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) without invasive mechanical ventilation (IMV) is particularly challenging. OBJECTIVES: To study ARDS patients treated with ECMO to avoid IMV-'primary awake ECMO'-or with extubation during ECMO support - 'extubated ECMO'. METHODS: International retrospective cohort of adult ARDS patients treated with ECMO without IMV at 14 centers in 8 countries (2015-2024). The primary outcome was mortality 90 days after ECMO initiation. MEASUREMENTS AND MAIN RESULTS: Among 307 adult patients with ARDS, 113 received 'primary awake ECMO' and 194 were extubated on ECMO. Ninety-day mortality was 30.1% in the 'primary awake ECMO' group and 14.9% in the 'extubated ECMO'. Strategy failure occurred in 46 patients (40.7%) and 47 patients (24.2%), respectively, most frequently within the first 10 days. In multivariate analysis, strategy failure was associated with 90-day mortality (hazard ratio 7.67 (3.44-17.11); P < .001 in 'extubated ECMO'; hazard ratio 5.95 (2.63-13.46); P < .001 in 'primary awake ECMO'), while higher age and longer time from ICU admission to ECMO cannulation were associated with 90-day mortality in 'extubated ECMO' and 'primary awake ECMO', respectively. The leading cause of strategy failure was worsening of respiratory failure, followed by agitation/delirium in 'primary awake ECMO' and inability to clear secretions in 'extubated ECMO'. CONCLUSIONS: 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.
Authors
- Philip Fortuna (ORCID: https://orcid.org/0000-0003-0325-9109)
- Quentin Moyon (ORCID: https://orcid.org/0000-0002-0223-5191)
- Matthias Lubnow (ORCID: https://orcid.org/0000-0002-4402-1810)
- João Ribeiro (ORCID: https://orcid.org/0000-0002-6596-3073)
- Ouriel Saura (ORCID: https://orcid.org/0000-0002-3565-3509)
- Felipe Becker
- Juliette Chommeloux
- Alessio Caccioppola (ORCID: https://orcid.org/0000-0003-1936-3111)
- Hadrien Winiszewski (ORCID: https://orcid.org/0000-0002-3728-2334)
- Tiago Petrucci
- Ana Rita Ferreira (ORCID: https://orcid.org/0000-0002-0178-8376)
- Vitalie Mazuru
- Santiago Freita
- Nina Buchtele (ORCID: https://orcid.org/0000-0002-1270-6452)
- Ana Luiza Valle
- Thorben Pape (ORCID: https://orcid.org/0000-0003-1031-1913)
- J Chico
- Thibault Vieille (ORCID: https://orcid.org/0000-0003-4838-0113)
- Bernhard Nagler
- Christoph Fisser (ORCID: https://orcid.org/0000-0001-5833-1230)
- Vanesa Gómez (ORCID: https://orcid.org/0000-0002-7793-531X)
- Klaus Stahl (ORCID: https://orcid.org/0000-0002-4833-6035)
- Hélio Martins
- Micha Landoll
- Carla Basílio (ORCID: https://orcid.org/0000-0002-2119-2633)
- Jeannine L. Kühnle
- Klaudia Podkowa (ORCID: https://orcid.org/0009-0008-1391-6065)
- Tiago Veiga
- Isabel Durães‐Campos
- Ana Rita Rodrigues (ORCID: https://orcid.org/0000-0003-0726-0123)
- Charles Edouard Luyt
- Konstanty Szuldrzynski
- Guiomar Castro
- A Combes
- B Seeliger
- Thomas Müller
- Mauro Panigada
- José Artur Paiva
- Lea Trummer
- David Levy
- Natalia Roman
- Roberto Roncon-Albuquerque
- Guillaume Hekimian
- Guillaume Lebreton
- Peter Schellongowski
- Matthieu Schmidt
- Philipp Lepper
- Christian Karagiannidis
- Sérgio Gaião
- Laura Santos
- Matthieu Petit
- Gael Piton
- Francisco Fonseca
- Ana Vaz
- Charles Juvin
- Paulo Figueiredo
- Giacomo Grasselli
- Rodrigo Pimentel
- Ana Rita Clara
- Marina P R Fantini
Institutions
- Inserm (FR)
- Witten/Herdecke University (DE)
- Universidade do Porto (PT)
- University of Milan (IT)
- University Hospital Complex Of Vigo (ES)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Hospital de São João (PT)
- University Hospital Regensburg (DE)
- Medizinische Hochschule Hannover (DE)
- Sorbonne Université (FR)
- Ospedale Maggiore (IT)
- Centre Hospitalier Universitaire de Besançon (FR)
- Comprehensive Cancer Center Vienna (AT)
- Universitätsklinikum des Saarlandes (DE)
- Centre de recherche en Epidémiologie et Santé des Populations (FR)
- Hôpital Marie Lannelongue (FR)
- Pitié-Salpêtrière Hospital (FR)
- Ministry of Interior (IT)
- German Center for Lung Research (DE)
- Ministry of Interior and Administration (PL)
- Sydney Local Health District (AU)
- Mylan (Switzerland) (CH)
- Hospital de Santa Maria (PT)
- Fondation pour l’innovation en Cadiométabolisme et Nutrition (FR)
- Mater Dei Hospital (BR)
- Imation (United States) (US)
- RWTH Aachen University (DE)
- Université de Franche-Comté (FR)
- Saarland University (DE)
Publication Details
- Journal
- American Journal of Respiratory and Critical Care Medicine
- Published
- 2026-05-01
- DOI
- https://doi.org/10.1093/ajrccm/aamag219
- Primary Topic
- Mechanical Circulatory Support Devices
- Type
- article
- Field-Weighted Citation Impact
- 0.00