Extracorporeal membrane oxygenation for avian influenza A (H7N9) patient with acute respiratory distress syndrome: a case report and short literature review

Abstract

BackgroundExtracorporeal membrane oxygenation (ECMO) is performed as an acceptable life-saving bridging procedure in patients with severe acute respiratory distress syndrome (ARDS).To patients with avian influenza A (H7N9)-associated ARDS, ECMO could be adopted as a feasible therapeutic solution. We present our successful experience with ECMO utilized in a respiratory failure patient with H7N9 infection.Case presentationA 44 years-old female with H7N9-induced ARDS was admitted to intensive care unit (ICU) and was treated with veno-venous ECMO for six days, antiviral therapy, prolonged corticosteroid infusion and other therapies. She suffered significant hemorrhage requiring transfusion of platelets and multidrug-resistant Acinetobacter Baumannii infection during ECMO support. Bleeding and infection almost killed the patient's life. Fortunately, she was alive at last and completly recovered after 38 days of ICU stay.ConclusionsECMO was effective in this H7N9 patient with a fatal respiratory failure. Mechanical circulatory support was the only chance for our patient with H7N9-associated ARDS to survive until respiratory function recovery. Early detection and rapid response are essential to these serious ECMO-associated complications such as hemorrhage, thrombosis and infection.

Fatty Acid Metabolism is Associated With Disease Severity After H7N9 Infection

“…The clinical, virological, immunological, and epidemiological features of human cases have been reported [ 8 , 16 , 24 , 52 ]. To treat such patients, immediate use of antiviral drugs and steroids is very common in the ICU, as is the use of MV or ECMO when necessary [ 2 , 36 ]. We also observed that epithelial barrier function was severely impaired in the lung biopsy specimen from a patient with laboratory-confirmed H7N9 infection.…”

“…As a result, endotracheal intubation and protective mechanical ventilation (MV) have become the mainstay of supportive therapy in the ICU [ 17 , 38 ]. Severe ARDS associated with H7N9 virus infection leads to the use of extracorporeal membrane oxygenation (ECMO), originally applied to support the respiratory function of pediatric patients [ 24 , 36 ]. Nevertheless, approximately 40% of patients do not survive these treatments, possibly because of the following three factors.…”

Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration

“…Existing studies of ECMO treatment for avian influenza A (H7N9) pneumonia are primarily limited to case reports [ 7 – 9 ], and no study has systematically reviewed the efficacy or safety of ECMO to treat such diseases. Therefore, it is particularly important to understand the current application of ECMO for avian influenza A (H7N9) pneumonia-induced severe ARDS, investigate the application timing and management strategies of ECMO, and explore the possible reasons for treatment failure.…”

Research progress on human infection with avian influenza H7N9

“…ECMO can be selected according to the conditions of patients. ECMO can effectively improve oxygenation and plays an important role in rescuing patients with severe H7N9 infection [18,[30][31][32][33][34][35][36][37]. Renal replacement therapy and artificial liver therapy may be used in patients with impending multiple organ dysfunction.…”