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Comment
. 2022 Jan 10;26(1):17.
doi: 10.1186/s13054-021-03880-3.

Choosing the right reference cohort for assessing outcome of venovenous ECMO

Alexander Supady  1   2   3 , Paul M Biever  4   5 , Dawid L Staudacher  4   5 , Tobias Wengenmayer  4   5
Affiliations
Comment

Choosing the right reference cohort for assessing outcome of venovenous ECMO

Alexander Supady et al. Crit Care. .
No abstract available

Keywords: COVID-19; Extracorporeal membrane oxygenation; Patient selection.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Graphical representation of the challenges of adequate patient selection for ECMO. A very liberal provision of ECMO (“ECMO for all”), considering ECMO for a large proportion of patients, both very severely and less severely diseased (A), will achieve the highest absolute number of ECMO survivors. This will be at the expense of a comparably high number of complications (fatal and non-fatal) in patients who would have survived even without ECMO and a large number of futile treatments. When ECMO is considered only for the sickest patients, the proportion of futile care is high and the overall ECMO survival is low; ECMO-related complications in healthier patients may be prevented at the expense of serious irreversible ventilator-induced lung injury, leading to invalidity or death (B). Positive preselection and provision of ECMO only for those patients that are having a high chance of survival will ensure prevention of irreversible lung injury, but at the expense of ECMO-related complications in a number of patients who would have survived even without ECMO. Overall survival of the entire cohort treated with ECMO and without is lowest, as compared to the other approaches (C). We argue for a strategy of rational ECMO use aiming at the optimal balance between “saved lungs” and limited complications on the one hand and “saved lives” and limited futile care on the other hand (D). This approach is likely to achieve the highest number of patients surviving in the entire cohort. ECMO extracorporeal membrane oxygenation
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