NEW YORK -- September 15, 2009 -- Patients with severe acute respiratory failure (ARF) should be referred for treatment using extracorporeal membrane oxygenation (ECMO), rather than using conventional ventilator management, to improve their chances of survival without disability, according to a study published online first and appearing in an upcoming edition of The Lancet.
Giles Peek, MD, Department of Cardiothoracic Surgery and Extracorporeal Membrane Oxygenation, Glenfield Hospital, Leicester, United Kingdom, and colleagues compared treatment by a specialised ECMO team with care from specialist intensive care unit teams using conventional ventilation, and also assessed the cost-effectiveness of referral for ECMO care.
In the UK-based randomised controlled trial, 180 adults were randomly assigned to receive continued conventional management (n = 90) or ECMO (n = 90). Eligible patients were aged 18 to 65 years and had severe but potentially reversible respiratory failure.
The primary outcome was death or severe disability at 6 months after randomisation. Data about resource use and economic outcomes (quality-adjusted life-years [QALYs]) were collected.
Researchers found that 68 of the 90 patients (75%) assigned to consideration of ECMO actually received it. Of those referred for consideration of ECMO, 63% survived to 6 months without disability compared with 47% of those who were assigned to conventional management. This is equivalent to 1 extra survivor without disability for every 6 patients treated. Consideration of ECMO treatment led to a gain of 0.03 QALYs at 6-month follow-up.
The cost per case was twice that for conventional treatment, but the cost-effectiveness was still well within the range regarded as cost-effective by health technology assessment organisations such as the National Institute for Health and Clinical Excellence (NICE).
"This study shows a significant improvement in survival without severe disability at 6 months in patients transferred to a specialist centre for consideration for ECMO treatment compared with continued conventional ventilation," the authors wrote.
"The cost-effectiveness of ECMO would be improved if costs of both transport and provision of the technique could be reduced...We are confident that ECMO is a clinically effective treatment for acute respiratory distress syndrome, which also promises to be cost effective in comparison with other techniques competing for health resources."
Dr Peek added that "[Influenza A(H1N1)] causes a viral pneumonia which can result in severe respiratory failure in young adults. We have already used ECMO during the first wave of the pandemic with good effect and we are expecting ECMO to prove an invaluable weapon in the fight against the winter resurgence of the infection, as has already been seen during the Australasian winter."
SOURCE: The Lancet