COMPARISON OF THE PROGNOSIS OF THE VENO VENOUS AND VENO-ARTERIAL ECMO: A SYSTEMATIC REVIEW

Mohamed Hassan Mohamed Gafow, Naima Omar Adan, Ahmed Abdirahman Ibrahim, Said Abdirahman Adan, Liu Hao, Dahir Adan Ali and *Zhou Jun

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is a life-saving technique used in critical care settings to support patients with severe respiratory or cardiac failure. This systematic review examines the prognostic outcomes associated with Veno-venous (VV) and Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO), focusing on survival rates, complications, and long-term consequences. A comprehensive literature search was conducted using PubMed, Embase, and Scopus, targeting studies published between 2014 and 2024. Inclusion criteria encompassed studies reporting survival, mortality, complications, and long-term outcomes in adult populations (≥18 years). Data from 42 eligible studies were extracted, synthesized, and assessed for quality using standardized tools. The review highlights a higher mortality rate for VA ECMO compared to VV ECMO, attributed to the severity of conditions treated, such as acute myocardial infarction and refractory cardiogenic shock. Factors including age, comorbidities, and complications such as infection and acute kidney injury significantly influenced outcomes. Dynamic prognostic models incorporating variables like lactate levels, pH, and bicarbonate offered superior predictive accuracy over static scoring systems. In contrast, VV ECMO demonstrated more favorable outcomes, especially in younger patients and trauma cases. Scoring systems such as SAVE and RESP provided valuable prognostic insights, while early intervention and effective management of complications, such as bleeding and severe acute kidney injury, were crucial in improving survival. Long-term survival and quality-of-life assessments indicated high return-to-work rates among ARDS patients treated with VV ECMO. This study underscores the importance of multidisciplinary teams, dynamic prognostic models, and refined treatment protocols to enhance ECMO outcomes. Future research should prioritize optimizing patient selection, improving the management of complications, and developing advanced predictive tools for tailored interventions.

Keywords: Veno-venous ECMO, Veno-arterial ECMO, Prognosis, Survival rates, Complications, Long-term Outcomes, Acute kidney injury, ARDS, Dynamic prognostic models, SAVE score, RESP score.