Two new studies on ECMO

Extracorporeal Membrane Oxygenation (ECMO) for severe respiratory failure features in two important papers recently.
The first, the CESAR trial, is an RCT showing a improvement in six-month disability-free survival in patients referred to an ECMO centre. The complexity of the study and the potential confounding factors led an editorialist to say: ‘This study will likely provide ammunition for both those in favour and those against the use of ECMO in the adult population‘.
Perhaps the Australasians have their own ammunition. In a paper describing the use of ECMO for patients with H1N1, they treated 68 patients with ECMO in three months, the same number of patients that actually received ECMO in the five year CESAR study!
Maybe the Aussies need to do a bigger, better RCT than CESAR?
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 Oct 17;374(9698):1351-63
Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome
JAMA. 2009;302(17) (Full text)
Further information on the impact of H1N1 on Australasian critical care services, and the 722 patients admitted to ICU with the disease, is published in the New England Journal:
Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand
N Engl J Med. 2009 Oct 8. [Epub ahead of print]

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