1, 4, 7
Continued conventional management at the referring centre
Referral and transfer to a single specialist ECMO centre
Randomised to referral, not to ECMO: only 68/90 (76%) of the referral arm actually received ECMO. Control arm had no protocolised lung-protective ventilation. Single ECMO centre.
Adults with severe but potentially reversible respiratory failure (Murray score >3 or pH <7.20)
Death or severe disability at 6 months
37% (33/90) vs 53% (46/87); RR 0.69 (95% CI 0.05-0.97), p=0.03
It does not isolate the effect of the ECMO circuit itself, and it does not describe a comparison against modern protocolised lung-protective ventilation.
A pathway of transfer to a specialist ECMO centre improved 6-month death-or-severe-disability compared with conventional management as delivered in 2001-2006.