ECMO in adults for severe respiratory failure finally comes of age: just in time?

The idea of employing cardiopulmonary bypass technology as a means of oxygenating (extracorporeal membrane oxygenation (ECMO)) or removing carbon dioxide (ECCO2R) in patients with acute respiratory failure (ARF) was first assessed in randomised controlled trials in the 1970s and 1980s.1 2 Poor rates of survival and major complications, particularly massive haemorrhage, led to most intensivists believing that ECMO was inappropriate in adults. A small number of centres worldwide—including that in Leicester, UK—continued to refine the use of ECMO in small numbers of adult patients whom it proved impossible to oxygenate by conventional means. Following the publication of their case series with improved results,3 Peek and colleagues embarked upon a randomised controlled trial of conventional ventilation or ECMO in patients with severe ARF (CESAR), the results of which have just been reported.4 Patients (n=766) were screened for inclusion over a 5-year period and those with potentially reversible severe ARF (defined as a Murray score >3 or …