• Petra L Graham and John L Moran.
• Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School and Department of Mathematics and Statistics, Faculty of Science and Engineering, Macquarie University, North Ryde, NSW 2109, Australia. Electronic address: petra.graham@mq.edu.au.
• J Crit Care. 2020 Oct 1; 59: 49-54.

PurposeA recent meta-analysis by Munshi et al. (Lancet Respiratory Medicine, 2019) claimed mortality treatment efficacy for extra corporeal membrane oxygenation (ECMO) in the acute respitratory syndrome (ARDS) despite very low meta-analytic study numbers (n = 2 (RCTs), risk-ratio (RR) 0·73 (95%CI: 0·58-0·92); n = 5 (2 RCT, 3 observational), RR 0·69 (95%CI: 0·50-0·95)). We explore this efficacy claim by a comprehensive re-analysis of the data.MethodsData were sourced from the two- and five-study meta-analyses, conducted using the Der-Simonian & Laird (DSL) method. A variety of frequentist (DSL, restricted maximum likelihood (REML), Paul-Mandel (PM), with/without Hartung-Knapp-Sidik-Jonkman variance correction), a beta-binomial model (BBN)) and Bayesian models (2 finite-mixture and several Markov-Chain-Monte-Carlo) were used to estimate treatment effects. Fragility-indices, the minimum patients changing mortality outcome needed to induce a conclusion change were also applied.ResultsFor the 2-study and 5-study meta-analysis only the uncorrected frequentist estimators (DSL, REML, PM) demonstrated significant RR. Except for the BBN model, which was significant for the 2-study meta-analysis, intervals for all other models included the null. Both meta-analyses demonstrated fragility.ConclusionsHaving canvassed the conduct of both meta-analyses presented by Munshi et al. and proffered alternative methods, we find no certainty regarding the efficacy of ECMO in ARDS.Copyright © 2020. Published by Elsevier Inc.

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