Extracorporeal Membrane Oxygenation for Critically Ill Patients With 2009 Influenza A (H1N1)‐Related Acute Respiratory Distress Syndrome: Preliminary Experience From a Single Center

Abstract

From early May 2009, the novel influenza A (H1N1) pandemic affected mainland China. Of those infected, a small proportion of patients developed acute respiratory distress syndrome (ARDS) so rapidly and severely that conventional ventilation treatment was ineffective. As an alternative treatment, the effect of extracorporeal membrane oxygenation (ECMO) was evaluated. From November 2009 to January 2010, all patients suffering from influenza A (H1N1)-associated ARDS referred to Beijing Anzhen Hospital for treatment with ECMO were enrolled. We describe the characteristics, treatment, and outcomes of these patients at 1- and 3-month follow-up. Nine patients (four females; mean age, 31.2 [21-59] years) from four centers were enrolled. All females had a history of recent pregnancy or had recently given birth. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a mean partial pressure of arterial oxygen/fraction of inspired oxygen of 52.9 ± 5.1 (45.0-63.8) mm Hg, positive end-expiratory pressure of 17.2 ± 4.2 cmH(2) O, and a Murray Lung Score of 3.6 (3.25-3.75). All nine patients were treated with veno-venous ECMO via percutaneous access. The mean duration of ECMO support was 436.6 ± 652.1 h (67.0-2160.0). At the end of 1-year follow-up, five patients (55.7%) were weaned from ECMO. Five patients (55.7%) survived to hospital discharge. Four patients (44.4%) died while undergoing ECMO. The mean length of intensive care unit and hospital stay was 4-204 days (median, 32) and 4-234 days (median, 38), respectively. There was no significant difference between survivors and nonsurvivors in the screened parameters. Use of ECMO for critically ill patients with 2009 influenza A (H1N1)-related ARDS is feasible and effective. However, this treatment is technically demanding. For success, careful selection of patients is crucial.

Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus

“…In patients with respiratory failure from H1N1 infection who required the use of ECMO, the survival rate varied considerably between studies ranging from 35 to 90% [15][16][17][18][19][20][21][22][23][24][25][26][27][28]. There was a large variation in survival rates, which could be explained by differences in patients' baseline characteristics and severity of illness.…”

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].…”

Severe Influenza Treatment Guideline

“…Most of the studies are case studies most of which are about the pandemic H1N1 in 2009. Reports have shown different mortality rates of severe influenza in which ECMO was applied between 8% and 75%, but the average mortality rate was 32%, indicating a relatively good effect [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. Therefore, it is recommended to apply ECMO to an influenza patient presenting continued hypoxia which does not respond to a conventional treatment (BIII).…”