Long-Term Mortality and Functional Outcomes After Extracorporeal Membrane Oxygenation in Critically Ill Adults: A Systematic Review and Meta-Analysis
In brief
One-year mortality ranges from 37% with venovenous ECMO to 74% with ECPR
A meta-analysis of 78,000 critically ill adults found that about 37% of those treated with venovenous ECMO survived to one year, compared with 45% for venoarterial ECMO and only 26% for extracorporeal CPR. Functional recovery was reported in fewer than a quarter of studies, highlighting a need for standardized outcome reporting to guide patient selection and counseling.
- Journal
- Critical care medicine (Q1)
- Published
- 31 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Kaylee T Stebbins, Chun Yee Yap, Lois Segun-Beloved, Alexandra M Hodgson, Anais Charles-Nelson, Ary Serpa Neto, et al.
- PMID
- 42671261
- DOI
- 10.1097/CCM.0000000000007318
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 6 September 2026): Long‑term mortality after ECMO in adults
Abstract
OBJECTIVES: To evaluate long-term all-cause mortality and functional outcomes among critically ill adults treated with extracorporeal membrane oxygenation (ECMO), including differences by ECMO modality and clinical indication. DATA SOURCES: Ovid MEDLINE, Embase, Emcare, Central Register of Controlled Trials, and Scopus were searched to March 2025. STUDY SELECTION: Randomized controlled trials and observational studies reporting mortality or functional outcomes at or beyond 6 months in adults receiving ECMO were eligible for inclusion. DATA EXTRACTION: A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and prospectively registered with PROSPERO (CRD420251002639). Two reviewers independently extracted data. Mortality was pooled using random-effects meta-analysis with 95% CIs. Prespecified subgroup analyses examined ECMO modality and clinical indication. Sensitivity analyses assessed the impact of missing outcome data. Functional outcomes were narratively synthesized due to heterogeneity. DATA SYNTHESIS: A total of 163 studies including 78,053 adults met inclusion criteria, with 59,454 adults in 156 of 163 studies (95.7%) contributing to mortality meta-analyses. At 1 year, pooled mortality was 37.2% (95% CI, 30.0-45.1%) in 13 of 33 venovenous ECMO studies (39.4%), 55.2% (95% CI, 50.2-60.1%) in 42 of 55 venoarterial ECMO studies (76.4%), and 74.4% (95% CI, 71.4-77.2%) in 14 of 24 (58.3%) extracorporeal cardiopulmonary resuscitation (ECPR) studies. Functional outcomes were reported in 38 of 163 studies (23.3%) in 7,876 survivors and were assessed using various instruments, most commonly the Cerebral Performance Category in 20 of 38 studies (52.6%), the World Health Organization Disability Assessment Schedule 2.0 in five of 38 studies (13.2%), and the modified Rankin Scale in five of 38 studies (13.2%). CONCLUSIONS: Long-term mortality following ECMO differed substantially by ECMO modality, ranging from 37.2% among adults receiving venovenous ECMO to 74.4% among adults receiving ECPR. Functional outcomes were inconsistently reported, limiting the understanding of functional recovery among survivors. Standardized reporting and benchmarking are required to better inform long-term prognosis, patient selection, and factors that may improve functional recovery after ECMO.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.