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Editorial |

Extracorporeal Membrane Oxygenation as a First-Line Treatment Strategy for ARDS:  Is the Evidence Sufficiently Strong?

William Checkley, MD, PhD
JAMA. 2011;306(15):1703-1704. doi:10.1001/jama.2011.1504.
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The 2009 influenza A(H1N1) pandemic was associated with a high attributable mortality among critically ill patients who developed acute respiratory distress syndrome (ARDS) and required mechanical ventilation. In this issue of JAMA, Noah and colleagues1 present evidence in support of extracorporeal membrane oxygenation (ECMO) in combination with lung protective ventilation as a treatment strategy early in the course of ARDS related to H1N1 infection. The authors found that among 80 patients with severe suspected or confirmed H1N1 and ARDS who were transferred to 4 UK specialized centers for treatment with ECMO, 22 died (27.5%) before hospital discharge.1 This mortality rate was lower than that among matched critically ill patients with equally severe (suspected or confirmed) H1N1 and ARDS who were not transferred for treatment with ECMO. This study adds to a series of recent investigations that favor the use of ECMO for severe respiratory failure in adults.13 In all of these studies, ECMO was initiated in the first 7 days of mechanical ventilation. Average duration of ECMO use was 9 to 10 days, and reported mortalities ranged from 21% to 37%.13

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