{"id":1434,"date":"2014-09-26T03:50:29","date_gmt":"2014-09-26T07:50:29","guid":{"rendered":"https:\/\/edecmo.org\/?p=1434"},"modified":"2014-09-26T03:50:29","modified_gmt":"2014-09-26T07:50:29","slug":"evid-ecmo-2-veno-venous-ecmo-ards-cesar-trial-anzic","status":"publish","type":"post","link":"https:\/\/edecmo.org\/evid-ecmo-2-veno-venous-ecmo-ards-cesar-trial-anzic\/","title":{"rendered":"Evid-ECMO 2: Veno-Venous ECMO in ARDS &#8211; The CESAR Trial &#038; ANZ-ECMO"},"content":{"rendered":"<!--powerpress_player--><div class=\"powerpress_player\" id=\"powerpress_player_9702\"><!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n<audio class=\"wp-audio-shortcode\" id=\"audio-1434-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20140925-evidecmo2-VV-ECMO-ARDS.mp3?_=1\" \/><a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20140925-evidecmo2-VV-ECMO-ARDS.mp3\">http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20140925-evidecmo2-VV-ECMO-ARDS.mp3<\/a><\/audio><\/div><p class=\"powerpress_links powerpress_links_mp3\" style=\"margin-bottom: 1px !important;\">Podcast: <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20140925-evidecmo2-VV-ECMO-ARDS.mp3\" class=\"powerpress_link_pinw\" target=\"_blank\" title=\"Play in new window\" onclick=\"return powerpress_pinw('https:\/\/edecmo.org\/?powerpress_pinw=1434-podcast');\" rel=\"nofollow\">Play in new window<\/a> | <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20140925-evidecmo2-VV-ECMO-ARDS.mp3\" class=\"powerpress_link_d\" title=\"Download\" rel=\"nofollow\" download=\"edecmo-20140925-evidecmo2-VV-ECMO-ARDS.mp3\">Download<\/a> (Duration: 21:00 &#8212; 19.3MB)<\/p><p class=\"powerpress_links powerpress_subscribe_links\">Subscribe: <a href=\"https:\/\/edecmo.org\/feed\/podcast\/\" class=\"powerpress_link_subscribe powerpress_link_subscribe_rss\" target=\"_blank\" title=\"Subscribe via RSS\" rel=\"nofollow\">RSS<\/a><\/p><p>Episode 2 of Evid-ECMO features \u00a0<a href=\"http:\/\/www.sharp.com\/san-diego-doctors\/dr-david-willms-52197\">Dr. David Willms<\/a>, who is the Director of Critical Care Medicine at Sharp Memorial Hospital. Dr. Willms has over 25 years of experience with VA and VV ECMO and is an amazing resource for us at our hospital. Dr. Willms has been a key player in the development of our highly successful ECMO program at Sharp. Zack and Dave discuss two of the &#8220;big&#8221; articles in VV-ECMO for ARDS:<\/p>\n<p>&nbsp;<\/p>\n<h3><strong><a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(09)61069-2\/fulltext\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-1442 size-thumbnail\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-9.08.29-PM-150x150.png\" alt=\"CESAR Trial\" width=\"150\" height=\"150\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-9.08.29-PM-150x150.png 150w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-9.08.29-PM-144x144.png 144w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-9.08.29-PM-32x32.png 32w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-9.08.29-PM-64x64.png 64w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-9.08.29-PM-96x96.png 96w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-9.08.29-PM-128x128.png 128w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>Article 1:<\/strong><em>\u00a0Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial <\/em><\/h3>\n<p><strong>PDF:<\/strong>\u00a0<a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/cesar-trial.pdf\">cesar-trial<\/a><\/p>\n<p style=\"padding-left: 30px;\"><strong>Identification:\u00a0<\/strong><\/p>\n<p style=\"padding-left: 60px;\"><strong>Title: \u00a0<\/strong><em>Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial<\/em><\/p>\n<p style=\"padding-left: 60px;\"><strong>Authors: \u00a0<\/strong>Giles J Peek, Miranda Mugford, Ravindranath Tiruvoipati, Andrew Wilson, Elizabeth Allen, Mariamma M Thalanany, Clare L Hibbert, Ann Truesdale, Felicity Clemens, Nicola Cooper, Richard K Firmin, Diana Elbourne, for the CESAR trial collaboration<\/p>\n<p style=\"padding-left: 60px;\"><strong>Location: <\/strong>UK-based multi-center trial<\/p>\n<p style=\"padding-left: 60px;\"><strong>Source:\u00a0<\/strong>Lancet. 2009 Oct 17;374(9698):1330<\/p>\n<p style=\"padding-left: 60px;\"><strong>PMID:<\/strong>\u00a019762075<\/p>\n<p style=\"padding-left: 30px;\"><strong>Introduction:<\/strong><\/p>\n<p style=\"padding-left: 60px;\"><strong>Problem<\/strong>: \u00a0Does ECMO provide improved safety, efficacy and cost-effectiveness, when compared to traditional therapy, in patients with severe ARDS?<\/p>\n<p style=\"padding-left: 60px;\"><strong>Significance:\u00a0<\/strong>This is the first positive RCT\u00a0that shows a statistically significant benefit of VV-ECMO for severe ARDS.<\/p>\n<p style=\"padding-left: 30px;\"><strong>Methods:<\/strong><\/p>\n<p style=\"padding-left: 60px;\"><strong>Study Type:\u00a0<\/strong>Randomized Controlled Trial<\/p>\n<p style=\"padding-left: 60px;\"><strong>Subjects:\u00a0<\/strong>180 adults with severe ARDS were randomized to receive conventional management or referral to ECMO center.<\/p>\n<p style=\"padding-left: 60px;\"><strong>Primary End-Point:\u00a0<\/strong>Death or severe disability at 6 months.<\/p>\n<p style=\"padding-left: 60px;\"><strong>Analysis:\u00a0<\/strong>Intention to treat<\/p>\n<p style=\"padding-left: 30px;\"><strong>Results\/<\/strong><strong>Conclusions:\u00a0<\/strong><\/p>\n<ul>\n<ul>\n<li><strong>Main conclusions:\u00a0<\/strong>\n<ul>\n<li>6 month survival without disability: 63% ECMO group vs. 47% conventional group.<\/li>\n<li>Quality-adjusted life years at 6 months: ECMO group showed a gain of 0.03 gain<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/ul>\n<p style=\"padding-left: 30px;\"><span style=\"text-decoration: underline;\"><strong>****THE BOTTOM LINE: \u00a0EDECMO Critical Assessment:<\/strong>\u00a0<\/span> If you need a paper to support your use of VV ECMO for severe ARDS, this is your ammunition.<\/p>\n<p>&nbsp;<\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<h3><a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=184800\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-1456 size-thumbnail\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-10.11.17-PM-150x150.png\" alt=\"Screen Shot 2014-09-25 at 10.11.17 PM\" width=\"150\" height=\"150\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-10.11.17-PM-150x150.png 150w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-10.11.17-PM-144x144.png 144w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-10.11.17-PM-32x32.png 32w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-10.11.17-PM-64x64.png 64w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-10.11.17-PM-96x96.png 96w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Screen-Shot-2014-09-25-at-10.11.17-PM-128x128.png 128w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>Article 2:<em> \u00a0Extracorporeal membrane\u00a0oxygenation\u00a0(ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and\u00a0266 patients\u00a0receiving\u00a0ECMO<\/em><\/h3>\n<p style=\"padding-left: 30px;\"><strong>PDF: \u00a0<a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/ANZ-ECMO.pdf\">ANZ ECMO<\/a><\/strong><\/p>\n<p style=\"padding-left: 30px;\"><strong>Identification:<\/strong><\/p>\n<p style=\"padding-left: 60px;\"><strong>Title:\u00a0<\/strong><em>Extracorporeal membrane\u00a0oxygenation\u00a0(ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and\u00a0266 patients\u00a0receiving\u00a0ECMO<\/em><\/p>\n<p style=\"padding-left: 60px;\"><strong>Authors:\u00a0<\/strong>The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators*<\/p>\n<p style=\"padding-left: 60px;\"><strong>Location:\u00a0<\/strong>Australia and New Zealand<\/p>\n<p style=\"padding-left: 60px;\"><strong>Context:<\/strong> \u00a0The novel influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter. It caused an epidemic of critical illness and some patients developed severe acute respiratory distress syndrome (ARDS) and were treated with extracorporeal membrane oxygenation (ECMO).<\/p>\n<p style=\"padding-left: 60px;\"><strong>Source:\u00a0<\/strong>JAMA, November 4, 2009\u2014Vol 302, No. 17<\/p>\n<p style=\"padding-left: 30px;\"><strong>Introduction:<\/strong><\/p>\n<p style=\"padding-left: 60px;\"><strong>Purpose:\u00a0<\/strong>To describe the characteristics of all patients with 2009 influenza A(H1N1)\u2013 associated ARDS treated with ECMO and to report incidence, resource utilization, and patient outcomes.<\/p>\n<p style=\"padding-left: 60px;\"><strong>Significance:\u00a0<\/strong><\/p>\n<p style=\"padding-left: 30px;\"><strong>Methods:<\/strong><\/p>\n<p style=\"padding-left: 60px;\"><strong>Study Type:\u00a0<\/strong>Retrospective Observational Study<\/p>\n<ul>\n<ul>\n<li><strong>Subjects:\u00a0<\/strong>All patients with 2009 influenza A (H1N1)- associated ARDS treated with ECMO<\/li>\n<\/ul>\n<\/ul>\n<p style=\"padding-left: 30px;\"><span style=\"text-decoration: underline;\"><strong>****THE BOTTOM LINE: \u00a0EDECMO Critical Assessment:\u00a0<\/strong><\/span> In 2009, VV ECMO was used with success to combat severe ARDS caused by Influenza A (H1N1).<\/p>\n<figure id=\"attachment_1461\" aria-describedby=\"caption-attachment-1461\" style=\"width: 210px\" class=\"wp-caption alignleft\"><a href=\"http:\/\/www.sharp.com\/san-diego-doctors\/dr-david-willms-52197\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1461\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/willms-david-52197-2013.jpg\" alt=\"David Willms MD Board Certified in Critical Care and Pulmonary Medicine\" width=\"210\" height=\"252\" \/><\/a><figcaption id=\"caption-attachment-1461\" class=\"wp-caption-text\">David Willms MD<br \/>Board Certified in Critical Care and Pulmonary Medicine<\/figcaption><\/figure>\n<p style=\"padding-left: 30px;\">If you have a question for Dr. Willms you may post it in the comments section below or email him directly at <a href=\"mailto:david.willms@sharp.com\" target=\"_blank\">david.willms@sharp.com<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Critical Review of 2 of the big papers on VV-ECMO for ARDS.<\/p>\n","protected":false},"author":4,"featured_media":1451,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[4],"tags":[98,97,56,24],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/09\/Three-dudes.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3JzC4-n8","_links":{"self":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/1434"}],"collection":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/comments?post=1434"}],"version-history":[{"count":0,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/1434\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media\/1451"}],"wp:attachment":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media?parent=1434"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/categories?post=1434"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/tags?post=1434"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}