CESAR Trial: ECMO vs. Ventilatory Support for Severe Adult Respiratory Failure
Submitted by Maggie Savelberg on Tue, 09/22/2009 - 08:44.
Dear All,
In lieu of our discussions surrounding the potential H1N1 pandemic and in trying to discern the role ECMO may play in treating these patients I thought the following article I spotted last week may be of some interest.
Peek and colleagues, published Sept 16, 2009 in The Lancet, a report on a multicenter randomized controlled trial (RCT) involving 180 patients (90 assigned to ECMO, and 90 to receive ventilatory support). The comparison looked at the efficacy and economic differences between treating patients with either method. In short, they were able to conclude that for patients with severe but potentially reversible respiratory failure, with a Murray score of 3.0 and a pH of less than 7.20 that transfer to ECMO would allow for improved survival without disability.
This study will become increasingly important as the physician's need to support costly decisions in transfering patients to ECMO, will need evidence-based literature to gain the required financial aid of the government.
Another article for the desktop! :)
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| Peek_2009_The-Lancet.pdf | 195.79 KB |
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Some interesting facts in an email on Perflist regarding the survival rates from the ELSO registry.
To: "Perflist"
Date: Sat, 26 Sep 2009 16:56:50 -0400
Subject: Adult ECMO Results from ELSO and H1N1 ECMO
Colleagues,
In order to clear up any possible confusion, the CESAR ECMO trial article comparing ECMO and Conventional medical management in Adult patients with respiratory compromise or ARDS showed a 16% BENEFIT.....NOT survival. The ECMO referral group having 63% survival compared to the conventional management 47% survival without disability.
On another note, the 36 ECMO cases of H1N1 recently submitted to the ELSO Registry have demonstrated a 59% survival, while the New Zealand/Australia data demonstrate survival in the 60-80% range depending on the institutions.
Overall survival rates from the ELSO Registry (July, 2009) for Adult ECMO in general are the following:
Bacterial Pneumonia 55%
Viral Pneumonia 63%
Aspiration 61%
ARDS Post-Op 52%
ARDS other 46%
ARF 58%
Other 47%
Bill Harris CCP
AmSECT/ELSO Liaison
Ochsner Medical Center
New Orleans