Extracorporeal Membrane Oxygenation Cannulation by Intensivists: A Systematic Review and Meta-Analysis

Purpose: To summarize the currently available evidence regarding the effectiveness and safety of extracorporeal membrane oxygenation (ECMO) cannulation performed by intensivists. Methods: We conducted a systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for studies of any design in which patients underwent ECMO cannulation by intensivists. The search was updated on Dec 15, 2024. Two independent authors screened titles and abstracts for general applicability, followed by full-text review to determine whether studies met the following criteria: (1) adult patients and (2) ECMO cannulation performed by intensivists. Two independent authors extracted study characteristics and outcomes of interest. The Freeman-Tukey double arcsine transformation was used to stabilize variance. A random-effects model was used to calculate the pooled complication rates. Results: A total of 209 studies were screened, and 12 retrospective, single-center studies were included. The pooled complication rate of ECMO cannulations performed by intensivists was 2% per cannula and 5% per patient. In the subgroup of VA ECMO cannulations, the complication rate was 9% per patient, whereas for VV ECMO cannulations, it was 4% per patient. Conclusions: ECMO cannulation by intensivists appears to be safe and feasible when supported by adequate training, credentialing processes, and backup support from surgeons in the event of complications such as vascular injury.