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New method helps respiratory failure patients

Monday September 21st, 2009

A high-tech treatment may be the best way to treat patients worst hit by the swine-flu and other critical lung diseases, researchers have reported.

The new study suggests that patients with severe acute respiratory failure would benefit from "extracorporeal membrane oxygenation" (ECMO), rather than conventional ventilation techniques.

Death and illness rates for patients with acute respiratory failure remain high. Such patients need intensive rehabilitation, often using intermittent positive-pressure ventilation, in which oxygen-enriched air is blown into the lungs at high pressure.

Dr Giles Peek of Glenfield Hospital, Leicester, UK, and colleagues looked at the effectiveness of ECMO, an alternative method where heart-lung bypass technology is used to provide gas exchange outside the body, allowing time for lung treatment and recovery.

They randomly assigned 180 adult patients to conventional management or ECMO, if appropriate. Ninety patients received conventional management, and 68 patients were suitable for ECMO - 75 per cent of the group.

In the Lancet, they report that 63 per cent of patients allocated to consideration for ECMO survived to six months without disability, compared with 47 per cent given conventional management. This equates to a 31 per cent reduced risk.

"Referral to consideration for treatment by ECMO treatment led to a gain of 0.03 quality-adjusted life-years at six-month follow-up," they write. The cost per quality-adjusted life-year, when using ECMO, is about 19,252 UK pounds, they estimate.

"We recommend transferring of adult patients with severe but potentially reversible respiratory failure to a centre with an ECMO-based management protocol to significantly improve survival without severe disability," they write.

"This strategy is also likely to be cost effective in settings with similar services to those in the UK."

Dr Peek added that ECMO has already been used during the first wave of the swine flu pandemic "with good effect".

Peek, G. J. 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. The Lancet, published online September 16, 2009.

Tags: A&E | Flu & Viruses | Respiratory | UK News

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