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EOLIA ECMO Referral Criteria — FRCA Final MCQ

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HardIntensive Care MedicineEOLIA ECMO Referral CriteriaFRCA Final

A 55-year-old woman (ASA III) in ICU with ARDS is receiving lung-protective ventilation. Despite optimal conventional management including prone positioning, her oxygenation remains critically poor (PaO2/FiO2 62 mmHg). She meets EOLIA trial referral criteria. What are the EOLIA trial criteria for ECMO referral?

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Correct answer: D — Any respiratory failure requiring FiO2 >0.5

The EOLIA trial (2018) referral criteria for venovenous ECMO in severe ARDS include: PaO2/FiO2 <50 for >3 hours, OR PaO2/FiO2 <80 for >6 hours, OR pH <7.25 with PaCO2 >60 mmHg for >6 hours, despite optimised conventional management (low VT ventilation, PEEP optimisation, prone positioning, neuromuscular blockade). Early referral to an ECMO centre is recommended. The EOLIA trial showed a trend towards mortality benefit with ECMO (35% vs 46%), reaching statistical significance in Bayesian post-hoc analysis.

Reference: Combes A et al – 2018 – EOLIA trial; NHS England – 2023 – ECMO referral criteria