Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada

Freed, Darren H.; Henzler, Dietrich; White, C.H.; Fowler, Robert; Zarychanski, Ryan; Hutchison, Jamie; Arora, Rakesh C.; Manji, Rizwan A.; Légaré, Jean‐François; Drews, Tanya; Veroukis, Stasa; Kesselman, Murray; Guerguerian, Anne‐Marie; Kumar, Anand

doi:10.1007/s12630-009-9253-0

Cited by 107 publications

(83 citation statements)

References 24 publications

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“…This finding consistent with published survival rates for ECMO worldwide during the H1N1 pandemic and suggest that ECMO is a viable therapy in both pediatric and adult patients with respiratory failure and refractory ARDS. [12][13][14] Consistent with prior reports that the H1N1 influenza attack rate was highest in adolescents and young adults, 2,18 6 of our patients were between 15 and 33 years old. Additionally, all but one of those 6 patients had an important underlying comorbidity, including the one patient under the age of 15, who had hypoplastic left-heart syndrome and had undergone the Fontan operation.…”

Section: Discussionsupporting

confidence: 88%

“…Prospective identification of patients who will benefit from ECMO remains quite difficult, despite decades of successful use in a wide range of clinical settings. 6,7,12,14,15,20 In the setting of refractory respiratory failure, however, reported ECMO survival is lower when lung injury is associated with comorbidities, especially in the setting of substantial immunocompromise or multiple organ dysfunction. 6,7,21 Our series demonstrates that ECMO can be successful in the presence of considerable underlying comorbidities in pediatric and adult patients, thus potentially expanding the pool of ECMO candidates.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11] In many centers, extracorporeal membrane oxygenation (ECMO) was employed as a rescue strategy for refractory acute respiratory distress syndrome (ARDS) due to H1N1 infection, in both adult and pediatric patients. [12][13][14] In the setting of refractory respiratory failure, ECMO has been an accepted and effective therapy in neonatal and pediatric patients for several decades. 6,7,15,16 In addition, data illustrating the success of ECMO in adult patients with ARDS emerged during the H1N1 pandemic and became even more relevant as large numbers of H1N1 infected adolescents and young adults required ICU admission.…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation for Severe Refractory Respiratory Failure Secondary to 2009 H1N1 Influenza A

Turner¹,

Rehder²,

Peterson‐Carmichael³

et al. 2011

Respir Care

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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.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation for Severe Refractory Respiratory Failure Secondary to 2009 H1N1 Influenza A

Turner¹,

Rehder²,

Peterson‐Carmichael³

et al. 2011

Respir Care

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“…Reports from Australia and New Zealand [1] and from France [2] indicate that patients on ECMO were 34% and 50% of the mechanically ventilated patients, respectively. In Hong Kong [3] and Canada [4] only 6% of the patients were shifted from conventional ventilation to ECMO. In the present study, 14 patients were referred to the regional center to initiate ECMO for refractory hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports describe cases of influenza A (H1N1)-associated acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) for severe hypoxemia refractory to conventional treatment [1][2][3][4][5][6]. However, uncertainty regarding the appropriate indication for ECMO in these patients still remains [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure

et al. 2012

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This is an author version of the contribution published on:Questa è la versione dell'autore dell'opera: [Intensive Care Medicine,38(3),2012, doi: 10.1007/s00134-012-2490 The definitive version is available at: La versione definitiva è disponibile alla URL: [http://download.springer.com/static/pdf/687/art%253A10.1007%252Fs00 134-012-2490 Conclusions:Abnormalities of chest wall mechanics may be present in some patients with influenza A (H1N1)-associated ARDS. These abnormalities may not be inferred from measurements of end-inspiratory plateau pressure of the respiratory system 1 (PPLAT RS ). In these patients, titrating PEEP on PPLAT RS may overestimate the incidence of hypoxemia refractory to conventional ventilation leading to un-appropriate use of ECMO.

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Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)

Noah

Peek

Finney

et al. 2011

JAMA

769

546

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Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada

Cited by 107 publications

References 24 publications

Extracorporeal Membrane Oxygenation for Severe Refractory Respiratory Failure Secondary to 2009 H1N1 Influenza A

Extracorporeal Membrane Oxygenation for Severe Refractory Respiratory Failure Secondary to 2009 H1N1 Influenza A

ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure

Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)

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