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We report four patients with pandemic H1N1 2009 influenza virus and secondary bacterial infection who were treated with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure. Three of the four patients had profound shock, necessitating support with venoarterial ECMO. Two patients died during ECMO support. The two survivors had prolonged hospital stays, which were complicated by renal failure and limb ischaemia.

SEVERE HYPOTENSION produces a loss of cerebral function, the extent and reversibility of which depends on the degree and duration of the period of hypotension. Recent studies have described the changes in cerebral function over periods of sustained hypotensionThe present study forms part of a systemic investigation which attempts to correlate the changes in cerebral blood flow during graded hemorrhagic hypotension with the subsequent alteration in cerebral functional activity and the development of hypoxic brain damage.This communication reports the changes observed in cerebral functional activity during hypotension and relates these changes to the arterial pressure and to the corresponding alterations in the cerebral circulation. The detailed accounts of the impairment of the cerebral circulation and development of brain damage due to hypotension are given in the accompanying papers. 5 ' 6 It has been suggested 7 that the somatosensory evoked response is a more accurate guide than the EEG to brain damage during hypotension. Therefore, both these parameters were measured in this study. Methods General DescriptionThe effect of graded hemorrhagic hypotension on electrocortical activity was determined in 2 parallel studies in a total of 12 cats, of either sex, weighing between 1.6 and 4.8 kg. Anesthesia and general Reprints: Dr. David I. Graham, the University of Glasgow, Wellcome Surgical Institute, Garscube Estate, Bearsden Road, Bearsden, Glasgow, G61 1QH, Scotland. preparation of the animals were identical to those described previously. Measurement of Somatosensory Evoked ResponseSix cats were used to study the effects of hypotension on the somatosensory evoked response. The cats were placed in a head-holder and the scalp was incised along the midline and reflected. A small craniotomy (approximately 1.5 X 1.0 cm) was made over the sensory cortex, using a saline-cooled dental drill, and a reference silver-electrode was implanted in the neck muscle. A supramaximal stimulus (0.5-2V, 0.2 msec, 1 Hz) was applied via a DISA type 14 E12 time base unit to the contralateral superficial radial nerve. Bipolar silver ball-tipped recording electrodes were then positioned (1 cm apart) on the surface of the dura to obtain maximal potential. Signals from the recording electrodes were amplified with a band width of 2-500 Hz and the average of 16 evoked potentials recorded with a DISA type 14 GO1 digital averager from which the measurements were taken and of which a photographic record was kept.The somatosensory evoked response was recorded for a control period of 30 min and then the animal was subjected to stepwise hypotension induced by controlled hemorrhage.5 Mean arterial pressure was decreased by approximately 10 mm Hg at each step and allowed to stabilize for approximately 10 min at each new level before the potentials were recorded. The effect of this hypotension on the evoked response was assessed in terms of the average peak-to-peak amplitude of the positive/negative sequence of the primary evoked response; 8 and t...

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A 37-year-old man presented with severe dilated cardiomyopathy secondary to occult aortic coarctation. He was successfully managed with combined orthotopic heart transplantation and aortic coarctation repair.