Extracorporeal membrane oxygenation 2001. The odyssey continues.
Extracorporeal membrane oxygenation was established as a standard of care by demonstrating its ability to save lives in moribund infants. The designs of early studies provided no living cohorts of similarly ill patients by which to measure accurately other (and perhaps to many more important) outcomes of interest: long-term neurodevelopmental outcomes or cost. Prospective cohort studies of neurodevelopmental outcomes post-ECMO demonstrate: (1) because ECMO, as used, saves lives, there will be an increase in the absolute number of handicapped children surviving; (2) there is little evidence that ECMO creates a relative increase in the percent of handicapped children surviving severe respiratory failure. The high direct costs of an ECMO program are measured and well publicized. When such costs are compared with similar therapies in other fields (in such terms as cost per survivor), the cost of ECMO does not seem to be an outlier. Trials of newer therapies, such as iNO, show the capacity to decrease the use of ECMO but have failed to demonstrate either cost-effectiveness or better long-term outcomes. It has not been shown that either society or individual patients have benefited from the decreased need for ECMO.
Schumacher
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Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Health Systems, Ann Arbor, Michigan, USA. neoschu@umich.edu
Baumgart
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D000280:Administration, Inhalation; D003362:Cost-Benefit Analysis; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000191:economics / Q000379:methods; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D021061:Liquid Ventilation; D009569:Nitric Oxide / Q000008:administration & dosage; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy; D014665:Vasodilator Agents / Q000008:administration & dosage
D011663:Pulmonary Surfactants; D014665:Vasodilator Agents; D009569:Nitric Oxide