This meta-analysis comparing venovenous (VV-ECMO) and venoarterial (VA-ECMO) extracorporeal membrane oxygenation for respiratory failure, encompassing 3,598 patients across eleven studies, found a significant survival advantage for the VV approach.

VV-ECMO was associated with nearly double the survival to hospital discharge in both pediatric (Odds Ratio [OR]: 2.01) and adult (OR: 1.90) populations.

While VA-ECMO patients were generally sicker at baseline, suggesting confounding by indication, the data strongly supports VV-ECMO as the superior strategy for isolated respiratory failure.

Furthermore, adult VV-ECMO patients had a significantly shorter Intensive Care Unit (ICU) length of stay (mean difference of $-20.00$ days).

In terms of complications, adult VA-ECMO was associated with a higher rate of hemolysis (12.7% vs. 7.3%), whereas pediatric VV-ECMO was linked to a higher risk of renal complications (OR: 1.33).

The study concludes that VV-ECMO should be the default strategy for patients with severe, isolated respiratory failure due to its significant survival benefit and shorter ICU stay. VA-ECMO should be reserved specifically for cases where there is clear, refractory cardiogenic shock accompanying the respiratory failure.

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