Quality Assurance Would Be Welcome
We congratulate our colleagues on their comprehensive review article on using extracorporeal lung support devices in patients with acute pulmonary distress syndrome (ARDS) (1). Technical improvements and the challenges in the context of the H1N1 influenza pandemic have undoubtedly led to a renaissance of extracorporeal membrane oxygenation (ECMO). The promising trend towards a reduced mortality associated with increasing experience in using the technique, as described by the authors, is indisputable and supports a recent publication from the United Kingdom’s ECMO-centers (2). Nevertheless this confirms primarily the positive correlation between dedicated center-based experience in treating severe ARDS and outcome, also mentioned in different expert discussions.
For this reason, the encouraging data from Regensburg and other specialized ECMO-centers should not prompt the uncritical popularization and use of extracorporeal lung support. In spite of miniaturised techniques and a simpler handling, ECMO remains a technically and pathophysiologically highly complex treatment modality that has to be supported by multimodal therapeutic management and expertise of different medical specialties.
The challenges inherent to the procedure, as well as the possible life-threatening complications, can only be met in centers that ensure comprehensive logistical and structural conditions at any time of day or night, as the authors rightly comment. On this background and from the perspective of the authors – and in analogy to the treatment of other diseases – quality assurance measures for the treatment of severe ARDS by using extracorporeal lung support would be extremely welcome (3).
PD Dr. med. Ralf Michael Muellenbach
Prof. Dr. med. Dr. h.c. Norbert Roewer
Prof. Dr. med. Peter Kranke, MBA
Klinik und Poliklinik für Anästhesiologie, Zentrum Operative Medizin,
Conflict of interest statement
The department of Anaesthesia and Critical Care at the University Hospitals of Würzburg is a specialised ARDS/ECMO center under the direction of PD Dr Ralf Muellenbach.
The authors declare that no conflict of interest exists.
|1.||Müller T, Bein T, Philipp A, Graf B, Schmid C, Riegger G: Extracorporeal pulmonary support in severe pulmonary failure in adults—a treatment rediscovered. Dtsch Arztebl Int 2013; 110(10): 159–66 VOLLTEXT|
|2.||Noah MA, Peek GJ, Finney SJ, et al.: Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA 2011; 306: 1659–68 CrossRef MEDLINE|
|3.||Zimmer KP: Neonatology departments under economic pressure. Dtsch Arztebl Int 2012; 109(31–32): 517–8 VOLLTEXT|