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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2010 December;76(12):1043-51
Extracorporeal membrane oxygenation for pandemic H1N1 2009 respiratory failure
Holzgraefe B. 1, Broomé M. 1, Kalzén H. 1, Konrad D. 1,3, Palmér K. 1, Frenckner B. 2 ✉
1 Section for Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Paediatric Anaesthesia and Intensive Care, ECMO Center Karolinska, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden;
2 Department of Paediatric Surgery, Astrid Lindgren Children’s Hospital, Stockholm, Sweden; 3Department of Cardiothoracic Surgery, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
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.