Prognostic Significance of Driving Pressure for Initiation and Maintenance of ECMO in Patients with Severe ARDS: A Systematic Review and Meta-analysis.
Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine•2025-03-20•PubMed
Total: 75.5Innovation: 7Impact: 8Rigor: 8Citation: 7
Summary
Across six studies (n=668), survivors had lower driving pressure at ECMO initiation. The pooled analysis supports an operational threshold of approximately 15 cm H2O for initiating ECMO in severe ARDS on mechanical ventilation.
Key Findings
- Survivors had lower driving pressure at ECMO initiation across pooled data.
- An approximate 15 cm H2O driving pressure threshold is supported for ECMO initiation in severe ARDS.
- Six studies (668 patients) were synthesized with registered protocol (PROSPERO CRD42022327846).
Clinical Implications
Consider initiating ECMO when driving pressure approaches/exceeds ~15 cm H2O despite optimal lung-protective ventilation, and monitor DP trajectories during ECMO.
Why It Matters
Provides an actionable, physiology-based threshold to guide timing of ECMO initiation in severe ARDS, a decision point with major prognostic implications.
Limitations
- Evidence synthesized largely from observational studies rather than RCTs
- Potential heterogeneity in ventilator settings and DP measurement across studies
Future Directions
Prospective validation of DP thresholds and randomized trials testing DP-guided ECMO initiation strategies.
Study Information
- Study Type
- Meta-analysis
- Research Domain
- Treatment
- Evidence Level
- I - Systematic review/meta-analysis with registered protocol informing clinical decision-making
- Study Design
- OTHER