EOLIA

1, 4, 7

Conventional management with ECMO permitted as rescue

Immediate VV ECMO

Stopped for futility at 75% of planned enrolment. 35/125 (28%) of controls crossed over to rescue ECMO; 20/35 (57%) of those died.

Very severe ARDS: PaO2/FiO2 <50 for >3 h, or <80 for >6 h, or pH <7.25 with PaCO2 >60 for >6 h

All-cause mortality at 60 days

35% (44/124) vs 46% (57/125); RR 0.76 (95% CI 0.55-1.04), p=0.09

It does not compare ECMO with no ECMO. With 28% crossover the trial compares early ECMO against rescue ECMO, and therefore cannot exclude a clinically important benefit.

Early ECMO in very severe ARDS produced an 11 percentage point absolute mortality difference that did not reach conventional significance in an underpowered trial.