HTA-funded research into serious respiratory failure publishes in The Lancet
News release from NETSCC, HTA
18 September 2009
New research suggests that patients with severe acute respiratory failure (ARF) should be treated using extracorporeal membrane oxygenation (ECMO), rather than conventional management, according to results in this week’s Lancet. The study was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme.
Mortality is high in severe ARF in adults despite improvements in ventilation techniques and other treatments (e.g. steroids, inhaled nitric oxide). Conventional management is by intermittent positive-pressure ventilation where oxygen enriched air is blown into the lungs at high pressure. This causes oxygen toxicity and pressure injury to the lung tissue on top of the underlying lung disease, delaying or preventing recovery. ECMO is an alternative treatment which uses heart-lung bypass technology to provide gas exchange outside the body, allowing time for recovery. There have, however, been reports complications such as bleeding arising following ECMO treatment.
Researchers, led by Mr Giles Peek, Professor Miranda Mugford and Professor Diana Elbourne compared treatment by a specialised ECMO team with care from specialist intensive care unit teams using conventional ventilation. They also assessed the cost-effectiveness of referral for ECMO care.
The researchers found that of the 90 patients who were transferred for consideration of ECMO, three quarters actually received ECMO and 63 per cent of these survived to six months without disability. This is compared with 47 per cent of those assigned to conventional management. This is equivalent to one extra survivor for every six patients treated.
Mr Peek concluded: “We are confident that ECMO is a clinically effective treatment for acute respiratory distress syndrome. It also promises to be cost-effective in comparison with other techniques competing for health resources.”
To view the project details visit www.hta.ac.uk/1150 and to view The Lancet article visit www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61069-2/fulltext
Notes for editors
1. The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme commissions research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 530 issues published to date. The journal’s 2009 Impact Factor (6.91) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk
2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
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