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The CESAR multicenter randomized trial compared referral to an expert center for consideration of ECMO with conventional ventilatory support in adults with severe, potentially reversible respiratory failure. The study was not a pure device-versus-device comparison: patients randomized to the ECMO strategy were managed within a specialist-center pathway that included lung-protective ventilation and the option of ECMO when appropriate. The trial found improved survival without severe disability at six months in the ECMO-referral group, helping establish referral to experienced ECMO centers as a potential strategy for selected patients with refractory respiratory failure. The publication is highly relevant to the NAPCON ECMO brain-storming session because it shifts attention from the machine itself to the referral system, expertise, patient selection and multidisciplinary infrastructure needed to use ECMO effectively. For non-metro centers, the practical message is that capacity building involves recognition of severe disease, timely referral and network design—not simply acquiring an ECMO circuit. The study also predates modern ECMO practice, so decisions today must incorporate contemporary selection criteria and evolving evidence.
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The CESAR multicenter randomized trial compared referral to an expert center for consideration of ECMO with conventional ventilatory support in adults with severe, potentially reversible respiratory failure. The study was not a pure device-versus-device comparison: patients randomized to the ECMO strategy were managed within a specialist-center pathway that included lung-protective ventilation and the option of ECMO when appropriate. The trial found improved survival without severe disability at six months in the ECMO-referral group, helping establish referral to experienced ECMO centers as a potential strategy for selected patients with refractory respiratory failure. The publication is highly relevant to the NAPCON ECMO brain-storming session because it shifts attention from the machine itself to the referral system, expertise, patient selection and multidisciplinary infrastructure needed to use ECMO effectively. For non-metro centers, the practical message is that capacity building involves recognition of severe disease, timely referral and network design—not simply acquiring an ECMO circuit. The study also predates modern ECMO practice, so decisions today must incorporate contemporary selection criteria and evolving evidence.
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