Fluid balance in ECMO patients


Schmidt M, Bailey M, Kelly J, Hodgson C, Cooper DJ, Scheinkestel C, et al. Intensive care medicine. 2014;40(9):1256-66.

Clinical question

Is early fluid balance status (within the first three days of ECMO initiation) associated with outcome in adult patients?


Retrospective observational study


Single- centre 45 bed ICU in Australia (Alfred Hospital, Melbourne)

March 2006- March 2013

CHEER 2015

CHEER 2015

Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion.

The CHEER protocol has been shown to improve survival with favourable neurological outcome following cardiac arrest compared with historical data. It works and works very well in this experienced ECMO centre, with engagement of pre-hospital services and as part of a bundle. A multi-centre RCT is now required to determine if these impressive results can be replicated.

Full Text Article: Stub D, et al. Resuscitation January 2015

by The Bottom Line

CESAR 2009

CESAR 2009

Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure. A multicenter randomised controlled trial.

The CESAR study supports ECMO as a valid treatment option for the management of patients with severe respiratory failure. However, it does not show that ECMO is better than conventional ventilation. With incomplete follow up data in nearly half of the patients and 24% of patients in the ECMO group not actually receiving ECMO, we are left with insufficient evidence as to whether ECMO is better or worse than protocolised ARDSnet ventilation in adults patients with severe respiratory failure. The study does highlight the importance of involving specialist units, effective lung protective ventilation and ECMO as an option in refractory respiratory failure.

Full Text Article:  Peek G. Lancet 2009;374

by The Bottom Line