Published in:
01-12-2017 | Editorial
Do we need randomized clinical trials in extracorporeal respiratory support? We are not sure
Published in: Intensive Care Medicine | Issue 12/2017
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It is difficult to say we do not need a clinical trial, especially on a controversial topic like extracorporeal respiratory support in respiratory failure. The use of these techniques has increased tremendously over the last few years, such that they are now probably overused [1]. Better definition of the indications for extracorporeal respiratory support would be welcome, as would more insight into optimal practice. Whether such questions can be answered by randomized controlled trials (RCTs) remains debatable, however, largely because of issues related to variability in protocol and practice (Table 1).
Table 1
Randomized controlled trials on extracorporeal respiratory support in respiratory failure: some hurdles
|
Hurdle
|
|
|---|---|
|
End points
|
|
|
Mortality
|
Defining entry criteria for optimal severity
Ethical aspects of randomizing life-saving therapy
Variability in end-of-life approach
|
|
Ventilator-induced lung injury
|
Hard to measure
(Small) benefit vs (small) risks
|
|
Comfort
|
Minimally invasive techniques not yet ready
(Small) benefit versus (small) risks
|
|
Logistics
|
|
|
Technical aspects
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Various ECMO techniques in use
Many unresolved issues about anticoagulation, respirator management, infection control, etc.
|
|
Center effects
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Variability in expertise and patient recruitment
|
|
Other management aspects
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Variability in other aspects of general patient management
|