Conventional ventilatory support versus ECMO for Severe Adult Respiratory failure (CESAR)
Multicentre randomised controlled trial
Patients were on pulmonary support alone with V V ECMO.
Background – ECMO uses CPB technology to provide gas exchange in severe ,reversible respiratory failure allowing ventilator settings to be reduced and lungs to recover with such 'lung-rest'.
AIM - To assess whether for patients with severe,reversible, respiratory failure ECMO increases the rate of survival without severe disability by 6 months and be cost effective compared to conventional ventilatory support.
Inclusion criteria -
Adult patients (18–65 years) with severe and potentially reversible respiratoryfailure.
Severe respiratory failure - Murray score ≥3.0 or uncompensated hypercapnia with a pH <7.20.
Exclusion criteria -
• Duration of high pressure (> 30 cm H2O PIP) and/or high FIO2 (> 0.8) ventilation > 7 days.
• Intra-cranial bleeding.
• Contra-indication to limited heparinisation.
• Patients who are moribund and have any contra-indication to continuation of active treatment.
Adult patients with severe,reversible respiratory failure within the said criteria on optimum conventional management have signi?cantly improved survival without severe disability on ECMO-based management protocol.
Giles J Peek, Miranda Mugford, Ravindranath Tiruvoipati, Andrew Wilson, Elizabeth Allen, Mariamma M Thalanany 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.
Giles J Peek,Felicity Clemens,Diana Elbourne,Richard Firmin,Pollyanna Hardy,Clare Hibbert et al. CESAR: Conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res. 2006; 6: 163.
Clinical opinion - Extracorporeal membrane oxygenation in adults. JP Johnston J R Coll Physicians Edinb 2010; 40:126–7