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Extracorporeal membrane oxygenation saves lives

The UK Collaborative ECMO Trial Group estimate that the technique, in which blood is pumped through an oxygenator and returned to the body, could save up to 200 babies at high risk of death from respiratory failure annually in the United Kingdom. This is "equivalent to one extra survivor for every three or four infants allocated ECMO," the trialists claim.

The latest research, published in the Lancet (1996:348:75-82), included 185 infants recruited from 55 British hospitals who were randomly assigned conventional care or transfer to one of the UK's five centres specialising in the technique. Researchers found that only 30 of the 93 infants allocated extracorporeal membrane oxygenation (32%) died, compared with 54 of the 92 allocated conventional care (59%). The difference in survival applied irrespective of the primary diagnosis, disease severity, and type of referral centre. No corresponding increase in the incidence of severe disability was found at one year.

"ECMO is clearly now an option to be actively considered before these babies become moribund," said researcher Dr Diana Elbourne, director of the perinatal trials service at Oxford's Radcliffe Hospital

The technique has been widely used in the United States since 1976, but definitive clinical trial results have been lacking until now.

"You could say that the US acted rashly without the data, yet have been proved right--up to 2000 babies' lives have been saved since its introduction in the US--whereas the UK held back until they had the evidence to satisfy their peers," said Roger Stoll, professor of paediatrics at the University of Vermont.

View larger version (108K): [in this window] [in a new window]   But Professor Stoll said less invasive, cheaper treatments such as nitric oxide, high frequency oscillation, and natural surfactant extracts may prove superior to extracorporeal membrane oxygenation, which costs around £50 000 ($75 000) per machine.--ALISON BOULTON, medical journalist, London

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