4, 66, 67
Treat the seven-day ventilation rule as a prompt to think harder rather than a gate, and treat age, obesity and frailty as risk modifiers rather than exclusions.
Not applicable
DOI 10.1177/02676591261424665
Not applicable - synthesis of selection, timing and organisational factors
Narrative synthesis of observational data; no randomised evidence on timing, frailty or centre volume.
Argues for individualised risk-benefit assessment over rigid exclusion criteria. Age relates continuously to mortality with no clear threshold. Obesity appears protective (obesity paradox), with comparable or superior survival in obese patients. Biological frailty may outperform chronological age, though recent Australian and New Zealand data on frailty and outcome are inconsistent. On timing, earlier retrospective analyses associated prolonged pre-ECMO ventilation with worse outcome but recent Japanese cohort data found no independent association; ECMO should not be unduly delayed once the indication is confirmed, but premature initiation carries unnecessary risk. Centre volume-outcome relationship remains controversial with conflicting analyses and no agreed threshold. Supports ECMO for very severe ARDS meeting EOLIA criteria when lung-protective ventilation alone cannot achieve adequate oxygenation.
Adults on VV ECMO