ECMO Outlook Greatly Exaggerated to the Public

News reports may contribute to unrealistic expectations about success with extracorporeal membrane oxygenation (ECMO) in the ICU, a study suggested.

Online media articles reported that their subjects were alive at the time of publication in 92.2% of cases after ECMO — a survival rate much higher than observed in large cohorts and randomized trials.

Less than half of news reports mentioned functional outcomes; those that did reported no disability in 88.0% of cases, a group led by Shannon Fernando, MD, MSc, of the University of Ottawa, reported in JAMA Internal Medicine.

“Together, this has the potential to mislead patients and families by not describing the substantial mortality and disability after ECMO. Recognition of this phenomenon of exaggerated benefit based on media reports may help clinicians frame realistic discussions with patients and families with respect to prognosis after ECMO,” Fernando and colleagues wrote.

“Furthermore, although ECMO may be beneficial for selected patients with critical illness, the ability to provide ECMO may be limited in some settings, highlighting the urgent need for conveying accurate information about patient selection and outcome,” they added.

Feel-good anecdotes from the news may go as far as to actually hurt critically ill patients and their families, according to an invited commentary by Jessica Holtzman, MD, and Sanket Dhruva, MD, MHS, both of the University of California San Francisco.

For instance, unrealistic media reports may complicate physician-patient discussions and lead to requests for transfer to specialty centers despite such transfer not being in the patient’s best interest. In addition, patients and family members may be discouraged from enrolling in any future ECMO trials, Holtzman and Dhruva suggested.

In 2008, the landmark CESAR trial showed that patients getting ECMO had a 63% rate of survival to 6 months without disability compared with 47% of patients randomized to conventional management. Since then, ECMO has become more popular in U.S. centers but remains relatively scarce.

The scarcity of ECMO has been exacerbated by the COVID-19 pandemic. Patients with better chances of surviving severe disease due to SARS-CoV-2 infection may be offered ECMO over their peers in the same hospital. However, there is no surefire way to judge who the best candidates are.

International registry data indicated a 37.4% incidence of 90-day in-hospital mortality among COVID patients receiving this therapy, researchers reported in September.

Fernando and colleagues had searched searched Google News and Bloomberg for English-language news articles from 1960 to 2020. They found 605 unique news story reports from 31 countries. Social media posts, peer-reviewed journal articles and case reports, and personal stories appearing on private, non-third party websites were excluded.

Subjects of those reports averaged 29.7 years of age, and 58.2% were men.

The study did not include stories from all news sources, the investigators acknowledged. However, what they did include “may reflect the most common stories encountered by patients and families who conduct online searches for ECMO,” they argued.

Ultimately, Holtzman and Dhruva urged that news organizations produce more balanced stories by noting the strengths and limitations of medical therapies like ECMO.

Physicians can also do their part by presenting nuanced evidence in traditional and social media. “By partnering with the media to provide realistic insights into current evidence and expected outcomes, physicians can advocate for the best interest of patients,” the duo said.

“With medicine squared centrally in the public eye, now more than ever we must encourage the media to accurately portray medical therapies. Public trust depends on it,” according to Holtzman and Dhruva.