Extracorporeal membrane oxygenation rescue for H1N1 acute respiratory distress syndrome: equipoise regained

In this issue of the Journal, Pham and colleagues (pp. 276?285) report patient outcomes after extracorporeal membrane oxygenation (ECMO) as a rescue therapy for acute respiratory distress syndrome (ARDS) during the 2009?2011 H1N1 influenza pandemic (1). Patients who received ECMO were compared with largely concurrent patients with H1N1 ARDS who did not have ECMO, by matching patient characteristics using propensity scoring. The pandemic timing did not permit a randomized controlled trial, but it provided a unique opportunity to study a substantial sample of patients receiving venovenous ECMO for ARDS in France from a single etiology. The REVA investigators are to be congratulated for building the impressive collaborative national network of clinician-investigators that enabled this research.