Original Title: Oxigenación por membrana extracorpórea en síndrome de distrés respiratorio agudo y trasplante pulmonar en adultos

Authors' recommendations: Moderate-quality evidence shows that support with venovenous extracorporeal membrane oxygenation in adults with acute respiratory distress syndrome produces a significant net benefit because it decreases mortality when compared to conventional mechanical ventilation. In addition, patients who receive this support have an increase in the number of days free from mechanical ventilation, kidney replacement therapy, vasopressor requirements and neurological events, and do not have a significant long-term negative impact on most dimensions of quality of life at hospital discharge. However, patients with acute respiratory distress syndrome who receive support with extracorporeal membrane oxygenation show a higher rate of adverse effects such as severe thrombocytopenia, bleeding requiring transfusion and higher risk of suffering anxiety symptoms than patients under conventional mechanical ventilation. Most of the clinical practice guidelines developed for acute respiratory distress syndrome in adults recommend adding support with venovenous extracorporeal membrane oxygenation in severe cases of hypoxemia and/or hypercapnia refractory to the standard supportive care. In Latin America, extracorporeal membrane oxygenation therapy for respiratory distress syndrome in adults is only covered in Mexico and Colombia. In the rest of the countries surveyed, coverage is either not provided or is not explicitly mentioned in their coverage policies. In high-income countries, only Germany and a private funder from the United States provide coverage. In Argentina, support therapy with extracorporeal membrane oxygenation for adult respiratory distress syndrome is not included in the mandatory medical program, but is eligible for reimbursement through the Unique System of Reimbursement for Disease Management. As regards the economic dimension, extracorporeal membrane oxygenation support therapy for adult patients with acute respiratory distress syndrome has been shown to be cost-effective in high-income countries. So far, no studies evaluating its cost-effectiveness or budget impact have been conducted in Argentina or in other countries of the region. Low quality evidence suggests that support with venovenous and/or venoarterial extracorporeal membrane oxygenation in adult patients undergoing lung transplantation may produce a minor net benefit because although its use is not associated with the development of primary graft failure, it has not been shown to improve mortality in this group of patients. It is associated with fewer days free of mechanical ventilation and prolongs hospital stay. Furthermore, the use of this technology in both venovenous and venoarterial modes may have a negative effect on survival when used as a rescue method prior to single-lung and double-lung transplantation and when used in patients with primary graft failure. Finally, the use of extracorporeal membrane oxygenation may be associated with a higher rate of severe and non-severe complications in patients undergoing lung transplantation compared to standard supportive care. Most clinical practice guidelines developed for lung transplantation in adults recommend the pre, intra and/or postoperative addition of support with extracorporeal membrane oxygenation in venovenous mode in patients with hypoxemia and/or hypercapnia refractory to the standard of care, as support in venoarterial mode in patients with cardiac dysfunction refractory to the standard of care and as the combination of both supports in cases where both conditions coexist. In Latin America, extracorporeal membrane oxygenation therapy for lung transplantation in adults is only covered in Mexico and Colombia. In the rest of the countries surveyed, coverage is not provided or is not explicitly mentioned in their coverage policies. In high-income countries, only Germany and three private funders from the United States provide coverage. In the rest of the high-income countries surveyed, coverage is either not provided or is not explicitly mentioned in their coverage policies. In Argentina, support therapy with extracorporeal membrane oxygenation for lung transplantation in adults is not included in the mandatory medical program, but is eligible for reimbursement through the Unique System of Reimbursement for Disease Management. As regards the economic dimension, so far, no studies evaluating the cost-effectiveness or the budget impact of extracorporeal membrane oxygenation support therapy for adult patients undergoing lung transplantation in high-income countries have been conducted in Argentina or in other countries of the region.

Project Status: Completed

Year Published: 2024

URL for published report: https://ets.iecs.org.ar/publication/2185

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: <p>Institute for Clinical Effectiveness and Health Policy (IECS)</p>