ClinicalIssuesEvidenceBasedPracticeinICU-CESARTrial.ppt

Collaborators’ meeting October 2004 The importance of the CESAR trial - Giles Peek Recruitment and enquiries – Ann Truesdale Ingredients for success – Luton Dunstable, Bedford Clinical concerns - Ravin Tiruvoipati Economics alongside CESAR - Miranda Mugford Follow-up of patients in trial - Andy Wilson Keynote speaker: Evidence based care in ICUs - David Goldhill The Importance of the CESAR Trial Giles J Peek MD FRCS (CTh) Lead Clinical Investigator What is the Population ? Adults (18-65 years) Severe, but potentially reversible respiratory failure Murray score 3.0, or Uncompensated hypercapnoea with a pH 7.20 Expected Survival Intensive Care National Audit Research Centre (ICNARC) The mortality of the 1,506 patients with a PaO2/FIO2 ratio of ?100 mmHg in this database was 61.6% Vasilyev; Chest 1995;107:1083-8 1426 patients in 25 university hospitals 1991-1992 Entry criteria: FIO250% 24 hours. Overall hospital survival: 55.6% Vasilyev; Chest 1995;107:1083-8. Severe Lung Injury: Murray 2.5 Survival=30% End Stage Lung Injury: Murray 3.5 Survival=18.4% FIO2 80%, Survival 20% Morris et al,Am J Respir Crit Care Med 1994;149:295-305. Randomised trial of PCIRV vs ECCO2R 19 PCIRV patients 8 survived Hospital survival = 42% Adult ECMO,AIMS DESIGN. Retrospective chart review of first 50 adult patients to receive ECMO for acute severe respiratory failure at Groby Road / Glenfield Primary end point: hospital survival Adult ECMO,INDICATIONS. Potentially reversible respiratory failure refractory to maximal conventional treatment Ventilated 7 days No contra-indication to heparin PATIENT STATUS AT REFERRAL. PaO2/FIO2 65mmhg Murray Score=3.4 Time Vent=76.5 hrs Time on 100% O2= 14 hrs. PAP = 39.6 cmH2O. PEEP = 10 cmH2O. MV = 12.6 L/min. MAP = 82 mmHg. MPAP = 29 mmHg. CVP = 12 mmHg. PAWP = 12 mmHg. CO = 127 ml/kg/min. UO = 1.4 ml/kg/hr. Age = 30.1 yrs. Wt = 71.9 Kg. Hb = 10.8 Kg. SURVIVAL BY DIAGNOSIS OUTCOME IN ADULTS WHEN ECMO IS UNAVAILABLE Pettifer R J*,