Extracorporeal membrane oxygenation for critically ill patients with 2009 influenza A (H1N1)-related acute respiratory distress syndrome: preliminary experience from a single center.

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.

Hou X ，Guo L ，Zhan Q ，Jia X ，Mi Y ，Li B ，Sun B ，Hao X ，Li H ... -  《-》

Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome: single-centre experience with 1-year follow-up.

Beurtheret S ，Mastroianni C ，Pozzi M ，D'Alessandro C ，Luyt CE ，Combes A ，Pavie A ，Leprince P ... -  《-》

[Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome caused by novel 2009 influenza A (H1N1) virus].

Zhan QY ，Sun B ，Tong ZH ，Guo LM ，Xu L ，Zhu X ，Jia XJ ，Wang C ... -  《-》

Portable miniaturized extracorporeal membrane oxygenation systems for H1N1-related severe acute respiratory distress syndrome: a case series.

Technological advances improved the practice of "modern" extracorporeal membrane oxygenation (ECMO). In the present report, we describe the experience of a referral ECMO center using portable miniaturized ECMO systems for H1N1-related severe acute respiratory distress syndrome (ARDS). An observational study of all patients with H1N1-associated ARDS treated with ECMO in Hospital S. João (Porto, Portugal) between November 2009 and April 2011 was performed. Extracorporeal membrane oxygenation support was established using either ELS or Cardiohelp systems (Maquet-Cardiopulmonary-AG, Hirrlingen, Germany). Ten adult patients with severe ARDS secondary to H1N1 infection (Pao(2)/fraction of inspired oxygen, 69 mm Hg [56-84]; Murray score, 3.5 [3.5-3.8]) were included, and 60% survived to hospital discharge. Five patients were uneventfully transferred on ECMO from referring hospitals to our center by ambulance. Six patients were treated during the first postpandemic influenza season. All patients were treated with oseltamivir, and 1 received in addition zanamivir. Four patients received corticosteroids. Nosocomial infection was the most common complication (40%). Of the 4 deaths, 2 were caused by hemorrhagic shock; 1, by irreversible multiple organ failure; and 1, by refractory septic shock. In our experience, ECMO support was a valuable therapeutic option for H1N1-related severe ARDS. The use of portable miniaturized systems allowed urgent rescue of patients from referring hospitals and safe interhospital and intrahospital transport during ECMO support.

Roncon-Albuquerque R Jr ，Basílio C ，Figueiredo P ，Silva S ，Mergulhão P ，Alves C ，Veiga R ，Castelo-Branco S ，Paiva L ，Santos L ，Honrado T ，Dias C ，Oliveira T ，Sarmento A ，Mota AM ，Paiva JA ... -  《-》

Extracorporeal membrane oxygenation for severe refractory respiratory failure secondary to 2009 H1N1 influenza A.

Turner DA ，Rehder KJ ，Peterson-Carmichael SL ，Ozment CP ，Al-Hegelan MS ，Williford WL ，Peters MA ，Noble PW ，Cheifetz IM ... -  《Respiratory Care》