Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study

Zapol, Warren M.; Snider, Michael T.; Hill, J. Donald; Fallat, Robert J.; Bartlett, Robert H.; Edmunds, L. Henry; Morris, Alan H.; Peirce, E. Converse; Thomas, Alison; Proctor, H. J.; Drinker, Philip; Pratt, Philip C.; Bagniewski, A.; Miller, RR

doi:10.1001/jama.242.20.2193

Cited by 646 publications

(240 citation statements)

References 14 publications

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“…The first multicenter, randomized trial to evaluate ECMO for ARDS was conducted by the NIH in the US in the 1970 s on 90 patients with severe ARDS refractory to conventional ventilation techniques [14]. The ECMO circuit had a venoarterial hook-up.…”

Section: Randomized Trials Of Ecmo In Ards Patientsmentioning

confidence: 99%

“…ECMO also permits ultraprotective mechanical ventilation to minimize the trauma caused by mechanical ventilation and to allow the lungs to rest [13]. Unfortunately, trials evaluating ECMO in this indication over the past few decades [14,15] failed due to the interval between the onset of disease and the installation of extra-corporeal assistance, the poor oxygenation and CO2-removal capacities of the devices used, and the high rate of complications linked to the apparatus (massive hemorrhage resulting from intense anticoagulation and the poor 'biocompatibility' of the circuits).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Indications for extracorporeal support: why do we need the results of the EOLIA trial?

Bréchot

Schmidt

2017

Med Klin Intensivmed Notfmed

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Section: Randomized Trials Of Ecmo In Ards Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Indications for extracorporeal support: why do we need the results of the EOLIA trial?

Bréchot

Schmidt

2017

Med Klin Intensivmed Notfmed

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“…This is because of increased cost and logistics but also because of disappointing results from the two previous randomized trials. 4,5 There has been renewed interest in adult ECMO due to encouraging results from case series, 6,7 improved ECMO technology, 2 general advances in critical care, 3,8 and, most recently, the use of ECMO in H1N1 patients. 9,10 In fact, CESAR was published electronically in the same month period as a retrospective case review of ECMO in adult respiratory failure 11 and a meta-analysis of ECMO following adult cardiac arrest.…”

Section: Critical Appraisalmentioning

confidence: 99%

“…This is because of increased cost and logistics but also because of disappointing results from the two previous randomized trials. 4,5 …”

mentioning

confidence: 99%

Extracorporeal membrane oxygenation (ECMO) in severe adult respiratory distress syndrome

Brindley

Cave

Lequier

2010

Can J Anesth/J Can Anesth

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Article assessedPeek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374: 1351-63. Critical care issueSevere adult respiratory distress syndrome (ARDS) remains associated with high mortality despite improved ventilatory techniques. While extracorporeal membrane oxygenation (ECMO) is not uncommon in neonatal/pediatric critical care, studies had yet to show similar benefits in adults. Therefore, the Conventional Ventilation or ECMO for Severe Adult Respiratory Failure (CESAR) Trial by Peek et al. 1 was eagerly anticipated. It was the first randomized study of ECMO in adult patients in over 15 yr and the largest ever concerning this condition. 2 Summary and key findingsIn this multicentre randomized control trial from the United Kingdom, 180 patients, aged 18-65 yr, were analyzed. The patients had severe but potentially reversible respiratory failure, a Murray Score of C 3.0 (determined by combining PaO 2 /F I 0 2 ratio, positive end expiratory pressure level, lung compliance, chest radiograph appearance, and F I 0 2 of 1.0), or uncompensated hypercapnea (pH \ 7.2) despite conventional treatment. They were randomized 1:1 to conventional management without transfer vs transfer to one site and consideration of ECMO. A greater proportion of patients randomized to consideration of ECMO were alive at six months compared with patients randomized to conventional management (63% or 57/90 vs 50% or 45/90, respectively). This outcome did not reach statistical significance (relative risk 0.73; 95% confidence interval [CI] [0.52-1.03]; P = 0.07). However, a significantly greater percentage of patients randomized to consideration of ECMO survived to six months without severe disability compared with patients randomized to conventional management (63% [57/90] vs 47% [41/87], respectively; relative risk 0.69; 95% CI [0.05-0.97]; P = 0.03). Referral for ECMO consideration was associated with 0.03 quality-adjusted years (QALYS) at six months. The cost per QALY for ECMO was 19,252 pounds sterling (GBP) (95% CI [7,200]). Despite conventional management, the authors concluded that it was appropriate to transfer adults with severe ARDS to a centre with an ECMO-based management protocol. Critical appraisalCurrent state of the literature and study relevance Extra corporeal membrane oxygenation is accepted as a standard-of-care for neonates and children with progressive respiratory and/or cardiac failure refractory to conventional management. [1][2][3] In contrast, adult ECMO is currently confined to a few specialized centres and reserved for exceptional cases. This is because of increased cost and logistics but also because of disappointing results from the two previous randomized trials. 4,5

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“…Thus it would seem preferable to use an index of oxygenation which is independent of ventilatory factors, such as PaO 2 (or Qs/Qt) on 60070 0 2 and 5 cm. H20 PEEP (as was used in the multicentre ECMO trial), [2] and a pressure-related index such as compliance over a stated volume range, which is less volume dependent than Paw.…”

mentioning

confidence: 99%

Acute respiratory distress syndrome

Hickling

1987

Intensive Care Med

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Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study

Cited by 646 publications

References 14 publications

Indications for extracorporeal support: why do we need the results of the EOLIA trial?

Indications for extracorporeal support: why do we need the results of the EOLIA trial?

Extracorporeal membrane oxygenation (ECMO) in severe adult respiratory distress syndrome

Acute respiratory distress syndrome

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