Use of Extracorporeal Membrane Oxygenation in Traumatic Injuries With Acute Respiratory Distress Syndrome: A Systematic Review And Meta-analysis

Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly used in severe acute respiratory distress syndrome (ARDS) when conventional mechanical ventilation (CMV) fails. While large trials such as CESAR and EOLIA have demonstrated ECMO’s benefit in general ARDS, trauma-induced ARDS remains underrepresented. This systematic review and meta-analysis aimed to assess ECMO’s efficacy and safety compared to CMV in adult trauma patients with ARDS. Methods: We systematically searched PubMed, Embase, and Cochrane Central up to March 2025 following PRISMA guidelines. Eligible studies included adult trauma patients with ARDS treated with ECMO (venovenous [VV] or venoarterial [VA]) versus CMV. The primary outcome was mortality; secondary outcomes included complications, ventilator-associated pneumonia (VAP), duration of mechanical ventilation, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Risk of bias was assessed using the ROBINS-I tool. Results: Four observational cohort studies (n = 1,526 patients) were included. ECMO was associated with significantly lower mortality (OR 0.29; 95% CI [0.14–0.62]; p = 0.001), with an even greater benefit in the VV ECMO subgroup (OR 0.19; 95% CI [0.07–0.53]; p = 0.002). ECMO recipients had significantly longer ICU stays (SMD 1.55; 95% CI [1.00–2.10]; p < 0.01) but no significant differences in total complications, VAP, or hospital LOS. Substantial heterogeneity was present across secondary outcomes, and sensitivity analyses identified specific studies contributing to variability. Conclusion: ECMO significantly reduces mortality in adult trauma-induced ARDS but is associated with prolonged ICU stay and notable resource demands. Further prospective, trauma-focused studies are needed to refine patient selection, optimize management, and improve long-term outcomes in this complex population.