Étude CESAR: Justification de l'assistance respiratoire extra corporelle pour les graves syndromes de détresse respiratoire de l'adulte

Background: Severe acute respiratory failure in adults still has a high mortality in adults despite improvements in ventilation techniques and other treatments. The evidence about the effectiveness of extracorporeal membrane oxygenation (ECMO) was equivocal. Method: National multi-center pragmatic randomized controlled trial. 180 adults (18-65 years) with severe (Murray score > 3.0 or pH < 7.2) but potentially reversible respiratory failure were randomized to receive either continued conventional management (CM) or to be transferred to Glenfield Hospital, Leicester, UK for consideration of ECMO. Patients were excluded if they had been on high pressure (> 30 cm H ₂O of peak inspiratory pressure) and/or high FiO₂ (> 0.8) ventilation for > 7 days; had signs of intra-cranial bleeding ; had any other contra-indication to limited heparinisation ; or had any contra-indication to continuation of active treatment. The primary outcome measure was death or severe disability at six months. Analysis was by intention to treat. Results: 766 patients were screened. 180 were randomised; 90 to the ECMO arm of whom 68 received ECMO. No cm patients received ECMO. Fewer patients in the ECMO arm than the cm arm had died or were severely disabled 6 months after randomisation, (33/90 (36.7%) vs 46/87 (52.9%) ; RR=0.69 (95%CI 0.50 to 0.97) ; p=0.030). Only one patient (in the cm arm) was known to be severely disabled at 6 months. Randomised controlled trial and economic evaluationControlled Trial of Conventional Ventilatory Support vs Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR) [ISRCTN47279827].