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Evidence-based guidelines for the use of extracorporeal membrane oxygenation in Australia and New Zealand using GRADE methodology series part 1: Venovenous extracorporeal membrane oxygenation (VV ECMO) indications and management

ANZICS/ANZ ECMO guideline group · 2026 · Australia

Source and licence

Authors
Sally F. Newman, Aidan Burrell, Hergen Buscher et al.
Title
Evidence-based guidelines for the use of extracorporeal membrane oxygenation in Australia and New Zealand using GRADE methodology series part 1: Venovenous extracorporeal membrane oxygenation (VV ECMO) indications and management
Journal
Critical Care and Resuscitation, 2026
DOI
10.1016/j.ccrj.2026.100163
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC12955552

Licence statement of the original publication

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Summary of the evidence

  • Recommendation 1In adult patients with severe hypoxic respiratory failure who fulfil EOLIA criteria, we suggest the use of VV ECMO in addition to standard care.Conditional recommendation, very low certainty of evidence due to very low certainty of evidence in critical outcomes other than short-term mortality.

Expert opinion on clinical application

  • We suggest the following criteria, adapted from those used in the EOLIA trial, when considering VV ECMO in addition to standard care for patients with severe hypoxic respiratory failure who meet diagnostic criteria for ARDS.14 (Table 3).

Summary of available evidence

  • Recommendation 2We are unable to make a recommendation for or against the use of VV ECMO for severe hypercapnic respiratory failure without ARDS.
  • No recommendation, no direct evidence.
  • Recommendation 4Mechanical ventilation during treatment with VV ECMO should maximise lung protective ventilation. ECMO treatment should be used to facilitate a reduction in parameters associated with lung injury, such as driving pressure, tidal volume and mechanical power. Acknowledging that high driving pressures seen in ARDS may be a marker of disease severity and therefore not necessarily modifiable.Good practice statement.

Abstract

We aim to provide evidence-based clinical practice guidelines for the use of VV ECMO in adult patients across Australia and New Zealand. Developed by a multidisciplinary panel of clinicians from both countries, alongside a methodologist and patient representatives, these guidelines were produced in accordance with the National Health and Medical Research Council (NHMRC) 2016 standards for guidelines. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess the certainty of evidence and inform the development of recommendations. These guidelines are intended to support, not replace, clinical judgement and should be applied in the context of individual patient circumstances, values and preferences. In this part one of a three-part series, the Guideline Development Group (GDG) addressed four core clinical questions regarding the indications for and management of VV ECMO in adults. In addition to evidence-based recommendations, this guideline incorporates expert consensus through a well-established process and highlights important gaps in current evidence to guide future research priorities.

Contents of the original publication

The section headings of the original.

  • Introduction
  • Methods
  • Question 1: in the management of adult patients with severe hypoxic respiratory failure, should VV ECMO or usual care alone be used?
  • Background
  • Summary of the evidence
  • Expert opinion on clinical application
  • Unresolved questions and research gaps
  • Question 2: in the management of adult patients with severe hypercapnic respiratory failure, should VV ECMO or usual care be used?
  • Background
  • Summary of available evidence
  • Expert opinion on clinical application
  • Unresolved questions and research gaps
  • Question 3: in the management of adult patients with ARDS receiving VV ECMO, should prone positioning or usual care alone be used?
  • Background
  • Summary of available evidence
  • Expert opinion on clinical application
  • Unresolved questions and research gaps
  • Question 4: in the management of adult patients with ARDS receiving VV ECMO, what is the best mechanical ventilation strategy?
  • Background
  • Summary of available evidence
  • Expert opinion on clinical application
  • Unresolved questions and research gaps
  • Conclusions
  • CReDiT authorship contribution statement

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