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

Published

Journal Article

BACKGROUND: Respiratory failure and acute respiratory distress syndrome secondary to H1N1 influenza infection is a source of substantial morbidity and mortality, having caused over 265,000 hospitalizations in the United States in 2009. During the H1N1 pandemic, up to 31% of the H1N1 patients required intensive care unit admission, and many were refractory to maximal conventional therapies. These most critically ill patients may require extracorporeal membrane oxygenation (ECMO) for survival. METHODS: We retrospectively reviewed the medical records of the 7 patients with refractory hypoxemia due to H1N1 influenza who were treated with ECMO in our pediatric intensive care unit. RESULTS: Five of the 7 patients survived to hospital discharge. The cohort's mean age was 21 years, and 4 were female. At admission to the pediatric intensive care unit, 6 had at least one comorbid condition, 6 were mechanically ventilated, and one was in shock. All 7 patients were treated with oral oseltamivir, high-frequency oscillatory ventilation, and inhaled nitric oxide prior to ECMO. Five received intravenous steroids, and 2 were treated with compassionate-use intravenous zanamivir. The mean duration of pre-ECMO ventilation was 8.7 days (range 14 h to 25 d). Mean oxygenation index was 50 (range 26-73) at ECMO cannulation. Six received venovenous ECMO, and one received venoarterial ECMO. The mean duration of ECMO was 432 hours (range 192-890 h). CONCLUSIONS: This series suggests that ECMO is a viable treatment for refractory hypoxemia secondary to H1N1 influenza infection in both pediatric and adult patients.

Full Text

Duke Authors

Cited Authors

  • Turner, DA; Rehder, KJ; Peterson-Carmichael, SL; Ozment, CP; Al-Hegelan, MS; Williford, WL; Peters, MA; Noble, PW; Cheifetz, IM

Published Date

  • July 2011

Published In

Volume / Issue

  • 56 / 7

Start / End Page

  • 941 - 946

PubMed ID

  • 21352668

Pubmed Central ID

  • 21352668

Electronic International Standard Serial Number (EISSN)

  • 1943-3654

International Standard Serial Number (ISSN)

  • 0020-1324

Digital Object Identifier (DOI)

  • 10.4187/respcare.01066

Language

  • eng