Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) severe respiratory failure in Japan

Abstract

PurposeTo evaluate procedures and outcomes of extracorporeal membrane oxygenation (ECMO) therapy applied to 2009 influenza A(H1N1) severe respiratory failure patients in Japan.MethodsThis observational study used database information about adults who received ECMO therapy for H1N1-related severe respiratory failure from April 1, 2010 to March 31, 2011.ResultsFourteen patients from 12 facilities were enrolled. Anti-influenza drugs were used in all cases. Before the start of ECMO, the lowest PaO2/FiO2 was median (interquartile) of 50 (40–55) mmHg, the highest peak inspiratory pressure was 30 (29–35) cmH2O, and mechanical ventilation had been applied for at least 7 days in 5 patients. None of the facilities had extensive experience with ECMO for respiratory failure (6 facilities, no previous experience; 5 facilities, one or two cases annually). The blood drainage cannula was smaller than 20 Fr. in 10 patients (71.4 %). The duration of ECMO was 8.5 (4.0–10.8) days. The duration of each circuit was only 4.0 (3.2–5.3) days, and the ECMO circuit had to be renewed 19 times (10 cases). Thirteen patients (92.9 %) developed adverse events associated with ECMO, such as oxygenator failure, massive bleeding, and disseminated intravascular coagulation. The survival rate was 35.7 % (5 patients).ConclusionECMO therapy for H1N1-related severe respiratory failure in Japan has very poor outcomes, and most patients developed adverse events. However, this result does not refute the effectiveness of ECMO. One possible cause of these poor outcomes is the lack of satisfactory equipment, therapeutic guidelines, and systems for patient transfer to central facilities.

Extracorporeal Life Support

“…Many groups in Europe, Asia, and the United States published their experience, adding to the worldwide catalogue of ECLS in the face of H1N1 influenza. 29–32 …”

Veno-Venous Extracorporeal Membrane Oxygenation for Acute Lung Injury after Surgery for Aortic Dissection: A Case Report

“…The use of too small of a blood drainage cannula might be an important factor contributing to the poor outcomes of VV-ECMO therapy for influenza A (H 1 N 1 ), an infectious disease that has been associated with severe respiratory failure in Japan [20]. The biggest point of reflection in the present case was that we used a 16.5-Fr cannula for venous drainage.…”

Extracorporeal Gas Exchange for Acute Respiratory Failure in Adult Patients: A Systematic Review

“…Mortality rates ranged from 14 to 64% in the 16 studies from 11 countries reporting on the experience of ECMO for influenza A(H1N1)-associated ARDS (Tables 4 and 5) [15][16][17]33,[37][38][39][40][41][42][43][44][45][46][47][48]. The Australia and New Zealand collaborative group (ANZICS) was the first to report its experience [15].…”