Eighty patients were referred, accepted, and transferred to 1 of the 4 UK ECMO centers, of whom 69 received ECMO (86.3 percent). From a pool of 1,756 patients, there were 59 matched pairs of ECMO-referred patients and non-ECMO-referred patients identified using individual matching, 75 matched pairs identified using propensity score matching, and 75 matched pairs identified using GenMatch matching.
Twenty-two patients (27.5 percent) who had been transferred to 1 of the 4 UK ECMO centers died. The researchers found that hospital mortality for matched non-ECMO-referred patients was approximately twice that of the ECMO-referred patients. "The hospital mortality was 23.7 percent for ECMO-referred patients vs. 52.5 percent for non-ECMO-referred patients when individual matching was used; 24.0 percent vs. 46.7 percent, respectively when propensity score matching was used; and 24.0 percent vs. 50.7 percent, respectively when GenMatch matching was used. The survival curves indicate a considerable number of early deaths among the non-ECMO-referred patients. The benefit of ECMO persisted after repeating the survival analysis and excluding the matched pairs in which either the ECMO-referred patient or the non-ECMO-referred patient died during the first 48 hours."
The authors write that the unique value of this study lies in the homogeneity of the patients and the matching methods used.
"The role of ECMO in ARDS is debated. Several reports and our study demonstrate that ECMO can be undertaken without the prohibitive morbidity and adverse events seen in the 1970s."
(JAMA.2011;306(15)doi:10.1001/jama.2011.1471. Available pre-embargo to the media at www.jamamedia.org)
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