Background: Extracorporeal membrane oxygenation (ECMO) is associated with significant inflammatory reactions that can impact patient outcomes. This meta-analysis aimed to evaluate the impact of ECMO on the functional ability of critically ill patients by comparing corresponding outcome indicators between ECMO and non-ECMO groups.

Methods: We conducted a systematic search of PubMed, Embase, Cochrane, and Clinical Trials databases for studies related to ECMO and inflammation published before April 30, 2024. Inclusion criteria comprised studies measuring inflammatory markers, including CRP, IL-6, and TNF-α in ECMO-treated patients.

Results: A total of 18 studies involving 1,245 patients met the inclusion criteria. The pooled results indicated a significant increase in markers such as IL-6 (standardized mean difference [SMD] = 0.58, 95% CI: 0.42-0.74, p < 0.001, I² = 53%) and TNF-α (SMD= 0.63, 95% CI: 0.48-0.79, p < 0.001, I² = 49%) in patients during ECMO support compared to their levels before initiation. Specifically, C-reactive protein (CRP) levels also showed a significant increase (SMD = 0.57, 95% CI: 0.39-0.75, p < 0.001, I² = 50%). Subgroup analysis revealed that VA ECMO was associated with a higher inflammatory response compared to VV ECMO (SMD = 0.65 vs. SMD = 0.50, p < 0.05). Patients receiving ECMO for longer than 7 days exhibited significantly higher levels of IL-6 and TNF-α compared to those with shorter ECMO durations.

Conclusion: ECMO is associated with a significant increase in systemic inflammatory markers, which varies by ECMO modality. These findings suggest that managing the inflammatory response may be crucial for improving outcomes in ECMO-treated patients..