IMPACT OF FLUID BALANCE ON OUTCOME OF ADULT PATIENTS TREATED WITH ECMO
Schmidt M, Bailey M, Kelly J, Hodgson C, Cooper DJ, Scheinkestel C, et al. Intensive care medicine. 2014;40(9):1256-66.
Clinical question
Is early fluid balance status (within the first three days of ECMO initiation) associated with outcome in adult patients?
Design
Retrospective observational study
Setting
Single- centre 45 bed ICU in Australia (Alfred Hospital, Melbourne)
March 2006- March 2013
The CHEER protocol has been shown to improve survival with favourable neurological outcome following cardiac arrest compared with historical data. It works and works very well in this experienced ECMO centre, with engagement of pre-hospital services and as part of a bundle. A multi-centre RCT is now required to determine if these impressive results can be replicated.
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.