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Objective <p>To compare short-term mortality and complication rates between venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in patients with severe respiratory failure.</p> Methods <p>A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed/MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Scopus database were searched for pertinent studies and clinical trials comparing VV- and VA-ECMO in respiratory failure. Statistical analysis was performed using the REVMAN 5.4 software. Pooled odds ratios (ORs) and mean differences (MD) with 95% confidence intervals (CIs) were calculated using a random-effects model.</p> Results <p>Eleven studies comprising 3,598 patients were included. VV-ECMO was associated with significantly higher survival to hospital discharge in both pediatric (OR: 2.01; 95% CI: 1.03–3.95; <i>p</i> = 0.04) and adult (OR: 1.90; 95% CI: 1.32–2.75; <i>p</i> = 0.0006) populations. VA-ECMO patients were consistently sicker at baseline, demonstrating significant confounding by indication. VA-ECMO was associated with a higher rate of hemolysis in adults (7.3% vs. 12.7%; <i>p</i> = 0.05), while VV-ECMO was linked to a higher risk of renal complications in pediatric patients (OR: 1.33; <i>p</i> = 0.005). Adult VV-ECMO patients had a significantly shorter ICU length of stay (MD: -20.00 days; <i>p</i> = 0.001).</p> Conclusion <p>In patients with severe respiratory failure, VV-ECMO is associated with a significant survival advantage over VA-ECMO, despite being used in less critically ill patients. VV-ECMO should be the default strategy for isolated respiratory failure, with VA-ECMO reserved for cases of clear, refractory cardiogenic shock.</p>

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Venovenous versus venoarterial extracorporeal membrane oxygenation in respiratory failure: a meta-analysis of mortality and complication rates

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月15日

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  • Hany A. Zaki,
  • Ahmed Shaban,
  • Eman E. Shaban,
  • Amira Shaban,
  • Ali Elkandow,
  • Mohamed Gafar Abdelrahim,
  • Mohammed F. Abosamak

摘要

Objective

To compare short-term mortality and complication rates between venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in patients with severe respiratory failure.

Methods

A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed/MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Scopus database were searched for pertinent studies and clinical trials comparing VV- and VA-ECMO in respiratory failure. Statistical analysis was performed using the REVMAN 5.4 software. Pooled odds ratios (ORs) and mean differences (MD) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Results

Eleven studies comprising 3,598 patients were included. VV-ECMO was associated with significantly higher survival to hospital discharge in both pediatric (OR: 2.01; 95% CI: 1.03–3.95; p = 0.04) and adult (OR: 1.90; 95% CI: 1.32–2.75; p = 0.0006) populations. VA-ECMO patients were consistently sicker at baseline, demonstrating significant confounding by indication. VA-ECMO was associated with a higher rate of hemolysis in adults (7.3% vs. 12.7%; p = 0.05), while VV-ECMO was linked to a higher risk of renal complications in pediatric patients (OR: 1.33; p = 0.005). Adult VV-ECMO patients had a significantly shorter ICU length of stay (MD: -20.00 days; p = 0.001).

Conclusion

In patients with severe respiratory failure, VV-ECMO is associated with a significant survival advantage over VA-ECMO, despite being used in less critically ill patients. VV-ECMO should be the default strategy for isolated respiratory failure, with VA-ECMO reserved for cases of clear, refractory cardiogenic shock.