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ECMO After EOLIA: The Evolving Role of Extracorporeal Support in ARDS

  • M. Salna
  • D. Abrams
  • D. BrodieEmail author
Chapter
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)

Abstract

Over the past decade, the rapidly expanding use of extracorporeal membrane oxygenation (ECMO) for the acute respiratory distress syndrome (ARDS) has outpaced the evidence. Before 2018, there had only been one large, randomized clinical trial involving relatively modern extracorporeal technology that evaluated the impact of ECMO on acute respiratory failure, predominately ARDS. Advances in ECMO technology, coupled with improvements in the management of ARDS, made it apparent that in order to clarify the role of ECMO for patients with severe forms of ARDS, further high-quality evidence would be needed [1]. The ECMO to Rescue Lung Injury in Severe ARDS (EOLIA) trial compared the impact of early venovenous ECMO (VV-ECMO) in patients with severe forms of ARDS against optimal conventional standard-of-care management [2]. Despite failing to meet the primary outcome of improved survival with ECMO at 60 days, the results of EOLIA are more nuanced than the trial conclusion might suggest. A comprehensive analysis of EOLIA provides valuable insights into the evolving role of ECMO and its future use in ARDS. This chapter will summarize the rationale for the trial, provide an in-depth interpretation of the results, and explore their implications on the role of ECMO in the management of ARDS.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Cardiothoracic Surgery, Department of SurgeryColumbia University Medical Center/NewYork-Presbyterian HospitalNew YorkUSA
  2. 2.Division of Pulmonary, Allergy, and Critical Care MedicineColumbia University Medical Center/NewYork-Presbyterian HospitalNew YorkUSA

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