Impact of Extracorporeal Membrane Oxygenation Following Cardiac Arrest on Organ Donation: A Systematic Review and Meta‐Analysis

Background Organ donation following cardiac arrest (CA) increasingly contributes to the donor pool. Extracorporeal membrane oxygenation (ECMO) is used in situ f or organ preservation in donation after circulatory death (DCD). ECMO is also used in refractory CA for cardiopulmonary resuscitation (ECPR), and, in selected patients with unfavorable neurological outcomes and diagnosed brain death, it can lead to donation after brain death (DBD). In this study, we performed a systematic review and meta‐analysis to assess the impact of ECMO use following CA on organ donation. Methods We searched three electronic databases (PubMed, Scopus, and Web of Science) and included single‐arm and comparative studies (ECMO versus other in situ organ preservation techniques). The organ use rate per donor was assessed. Results We included 69 primary observational studies (15 comparative). The most common clinical scenario was controlled DCD ( n = 49), followed by uncontrolled DCD ( n = 23), and DBD ( n = 8). Multiorgan donation occurred in 88% of DBD cohorts, 46% of controlled DCD, and 22% of uncontrolled DCD. The overall meta‐analytic effect measure from comparative studies showed that ECMO is associated with a higher organ use rate than other techniques (RR 1.17, 95% CI 1.01–1.36, I 2 = 82.4%). Subgroup analyses across clinical scenarios and comparator techniques showed that estimates favored ECMO in controlled and uncontrolled DCD, without statistical significance. In DBD post ECPR, no benefit of ECMO was observed. Conclusions ECMO is likely superior to other techniques in controlled DCD. In uncontrolled DCD, underpowered evidence favored ECMO. In DBD following ECPR, no clear advantage of ECMO‐based preservation is demonstrated.