Authors' objectives:

CESAR (Conventional ventilation or ECMO for Severe Adult Respiratory failure) was a nationwide UK RCT whose primary hypothesis was that ECMO will improve survival without severe disability at 6 months for adults (18–65 years) with severe (Murray lung injury score ≥ 3.0 or pH < 7.2) but potentially reversible respiratory failure and will be cost-effective.

Authors' recommendations: A major limitation of this study is the lack of standardisation of care in the conventional arm. This was because it was not possible for the conventional intensive care providers to reach a consensus as to what constituted optimal care. An alternative strategy of transferring all the patients to Glenfield to be cared for by the ECMO team was dismissed by collaborators as they did not consider the ECMO team to be sufficiently expert in the provision of conventional intensive care. The other possibility considered was to use a single centre to provide all of the conventional care, but this was impossible as such a centre does not exist in the UK. The trial team therefore took the pragmatic decision to recommend what was proven to be the best ventilation strategy (the low volume ARDSNet protocol) but allow individual intensivists to determine what they thought was the best treatment for their patients. If this decision had not been taken then it would not have been possible to conduct the study. This pragmatic design meant that CESAR was comparing treatment in an expert centre where ECMO was part of the treatment algorithm with the treatment available to the general public in the UK as a whole. Compared with CM, transferringadult patients with severe but potentially reversible respiratory failure to a single centre specialising in the treatment of severe respiratory failure for consideration of ECMO significantly increased survival without severe disability. Use of ECMO in this way is likely to be cost-effective when compared with other technologies currently competing forhealth resources.

Project Status: Completed

URL for project: http://www.hta.ac.uk/1150

Year Published: 2010

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

Copyright: 2010 Queen’s Printer and Controller of HMSO