Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure. A multicenter randomised controlled trial.
The CESAR study supports ECMO as a valid treatment option for the management of patients with severe respiratory failure. However, it does not show that ECMO is better than conventional ventilation. With incomplete follow up data in nearly half of the patients and 24% of patients in the ECMO group not actually receiving ECMO, we are left with insufficient evidence as to whether ECMO is better or worse than protocolised ARDSnet ventilation in adults patients with severe respiratory failure. The study does highlight the importance of involving specialist units, effective lung protective ventilation and ECMO as an option in refractory respiratory failure.