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Comment by gagagaga7 | Hacker News Reader

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.0...

An interesting european study where patients with heart failure were randomized to ecmo or not ecmo, with no significant difference

Studies like this are not often run in the us because there isnt a national health service which can facilitate this sort of trial, and no industry corporation has an incentive to run this either

So when dealing with very expensive complex treatments which sometimes seem to “work” impressively, remember that it may be completely useless

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As others have mentioned, it's important to note that this is not a trial of ECMO vs no ECMO, but of immediate ECMO vs usual care including ECMO if needed, and that 39% of the control arm wound up receiving ECMO, which could have the effect of reducing apparent treatment benefit. Also, the 28% reduction in the primary endpoint could well reach statistical significance if the trial numbers were larger. Finally, this was for patients with cardiogenic shock, most likely predominantly heart attack patients. They likely represent a smallish portion of the patients who might be considered for ECMO, so one can't generalize to all scenarios.

You’re mischaracterizing their findings:

>” Immediate implementation of VA-ECMO in patients with rapidly deteriorating or severe cardiogenic shock did not improve clinical outcomes compared with an early conservative strategy that permitted downstream use of VA-ECMO in case of worsening hemodynamic status.”

They still allowed for the use of ECMO if things got worse, they just didn’t start early. I don’t know how enough to know how this trial’s treatment compares to standard practice.

I’d be careful interpreting studies when you aren’t a domain expert. Even if the results are accurate (no reason to think they’re not in this case), subtleties of experimental design that a domain expert would see may be invisible to an outsider.

In this area, some groups are able to demonstrate a benefit and others are not. The thought is that hospital integration with field technicians is a big explanatory factor

“Of the three published ECPR randomized, controlled trials, only one did not limit the intervention to people with shockable rhythms. That ambitious trial, in Prague, included patients whose hearts were in the same P.E.A. pattern as the St. Paul man’s. The study was stopped early when it appeared that ECPR wasn’t saving significantly more people than standard care was. These enigmatic cases that lack shockable rhythms are vexing: When the Prague data was reanalyzed without these patients, the findings were favorable for ECPR.”

https://www.nytimes.com/2024/03/27/magazine/ecpr-cardiac-arr...

>and no industry corporation has an incentive to run this either.

Are insurance companies not incentivized to measure cost effectiveness of treatments in the US?

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