Does Extracorporeal Membrane Oxygenation Improve Survival in Pediatric Acute Respiratory Failure

Rationale: Extracorporeal membrane oxygenation (ECMO) has supported gas exchange in children with severe respiratory failure for more than 40 years, without ECMO efficacy studies.Objectives: To compare the mortality and functional status of children with severe acute respiratory failure supported with and without ECMO.Methods: This cohort study compared ECMO-supported children to pair-matched non–ECMO-supported control subjects with severe acute respiratory distress syndrome (ARDS). Both individual case matching and propensity score matching were used. The study sample was selected from children enrolled in the cluster-randomized RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) clinical trial. Detailed demographic and daily physiologic data were used to match patients. The primary endpoint was in-hospital mortality. Secondary outcomes included hospital-free days, ventilator-free days, and change in functional status at hospital discharge.Measurements and Main Results: Of 2,449...