Treatments for Acute Respiratory Failure Compared

Extracorporeal membrane oxygenation improves survival without disability for respiratory failure
By Jeff Muise
HealthDay Reporter

WEDNESDAY, Sept. 16 (HealthDay News) -- For patients suffering acute respiratory failure, extracorporeal membrane oxygenation (ECMO) is superior to conventional ventilation support in terms of survival without disability, according to a study published online Sept. 16 in The Lancet.

Giles J. Peek, M.D., of Glenfield Hospital in Leicester, U.K., and colleagues randomized 180 adults with acute respiratory failure to receive either cardiopulmonary bypass with ECMO or conventional ventilation support. The two groups were compared for death and severe disability at six months after randomization or before hospital discharge. The researchers also performed cost studies, including cost-utility at six months after randomization and lifetime cost-utility.

In this intention-to-treat study, the researchers found that just 68 of the 90 patients allocated to receive ECMO actually did. In the entire ECMO allocation group, 57 of the 90 patients (63 percent) survived to six months without disability compared to 41 of 87 patients (47 percent) allocated to conventional respiratory support. While the cost per case was twice that of conventional treatment, ECMO referral was still deemed cost-effective.

"We recommend transferring of adult patients with severe but potentially reversible respiratory failure, whose Murray score exceeds 3.0 or who have a pH of less than 7.20 on optimum conventional management, to a center with an ECMO-based management protocol to significantly improve survival without severe disability. This strategy is also likely to be cost effective in settings with similar services to those in the U.K.," the authors write.

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