Extracorporeal membrane oxygenation for pandemic H1N1 2009 respiratory failure
2010 (English)In: Minerva Anestesiologica, ISSN 0375-9393Article in journal (Refereed) Published
BACKGROUND: Severe respiratory failure related to infection with the pandemic influenza A/H1N1 2009 virus is uncommon but possibly life-threatening. If, in spite of maximal conventional critical care, the patient's condition deteriorates, extracorporeal membrane oxygenation (ECMO) may be a life-saving procedure. METHODS: An observational study approved by the local ethics committee was carried out. Data from all patients treated with ECMO at the ECMO Center Karolinska for influenza A/H1N1 2009-related severe respiratory failure were analyzed. The main outcome measure was survival three months after discharge from our department. RESULTS: Between July 2009 and January 2010, 13 patients with H1N1 2009 respiratory failure were treated with ECMO. Twelve patients were cannulated for veno-venous ECMO at the referring hospital and transported to Stockholm. One patient was cannulated in our hospital for veno-arterial support. The median ratio of the arterial partial oxygen pressure to the fraction of inspired oxygen (P/F ratio: PaO2 /FiO2) before cannulation was 52.5 (interquartile range 38-60). Four patients were converted from veno-venous to veno-arterial ECMO because of right heart failure (three) or life-threatening cardiac arrhythmias (one). The median maximum oxygen consumption via ECMO was 251 ml/min (187-281 ml/min). Twelve patients were still alive three months after discharge; one patient died four days after discharge due to intracranial hemorrhage. CONCLUSION: Patients treated with veno-venous or veno-arterial ECMO for H1N1 2009-related respiratory failure may have a favorable outcome. Contributing factors may include the possibility of transport on ECMO, conversion from veno-venous (v-v) or veno-arterial (v-a) ECMO if necessary, high-flow ECMO to meet oxygen requirements and active surgery when needed.
Place, publisher, year, edition, pages
Adult, Analgesics/therapeutic use, Anoxia/therapy, Cohort Studies, Cross Infection/therapy, *Extracorporeal Membrane Oxygenation/adverse effects/instrumentation, Female, Humans, Hypnotics and Sedatives/therapeutic use, *Influenza A Virus, H1N1 Subtype, Influenza, Human/complications/*therapy/virology, Male, Middle Aged, Pandemics, Pregnancy, Respiration, Artificial, Respiratory Function Tests, Respiratory Insufficiency/etiology/*therapy/virology, Treatment Outcome
Anesthesiology and Intensive Care
IdentifiersURN: urn:nbn:se:kth:diva-58863PubMedID: 21178913ISBN: 1827-1596 (Electronic) 0375-9393 (Linking)OAI: oai:DiVA.org:kth-58863DiVA: diva2:474816
QC 201201162012-01-102012-01-092012-01-16Bibliographically approved