TY - JOUR T1 - Extracorporeal lung assist: more than kicking a dead horse? JF - European Respiratory Journal JO - Eur Respir J SP - 1431 LP - 1432 DO - 10.1183/09031936.00146408 VL - 32 IS - 6 AU - M. M. Hoeper AU - T. Welte Y1 - 2008/12/01 UR - http://erj.ersjournals.com/content/32/6/1431.abstract N2 - Up to now, the history of extracorporeal lung support has been a tale of great expectations and even greater disappointments. In 1972, Hill et al. 1 published the first case report on the use of extracorporeal membrane oxygenation (ECMO) in a young patient who suffered from acute respiratory distress syndrome (ARDS) after trauma. At that time, mortality rates from ARDS were extremely high and thus this report was embraced with great enthusiasm. However, only 2 yrs later reality caught up when the results of a randomised controlled trial using ECMO in ARDS were published showing mortality rates of >90% in both treatment arms 2. Despite these sobering results, several groups of investigators continued to work on extracorporeal devices. Gattinoni and co-workers 3, 4 were the first to introduce the use of extracorporeal CO2 removal to support protective ventilation strategies, now with survival rates of ∼50% among patients with ARDS. However, once again a randomised controlled trial failed to show a survival benefit in ARDS patients treated with extracorporeal CO2 removal 5 although the survival rates (33% in the extracorporeal group versus 42% in the conventional ventilation group) were now substantially better than in the 1970s. The reasons for the failure to demonstrate a survival benefit with extracorporeal lung support were certainly manifold. The study by Morris et al. 5 included only 40 patients and was gravely underpowered (for comparison, the ARDS Network trial on low tidal volumes recruited >800 patients before a survival difference of 22% became statistically significant 6). More importantly, the … ER -