Extracorporeal membrane oxygenation for cardiorespiratory failure in four patients with pandemic H1N1 2009 influenza virus and secondary bacterial infection

Buckley, Erin M.; Sidebotham, David; McGeorge, Alastair; Roberts, Sophia; Allen, Sara Jane; Beca, John

doi:10.1093/bja/aep396

Cited by 23 publications

(25 citation statements)

References 7 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: 89%

“…[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: 89%

Section: Introductionmentioning

confidence: 99%

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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“…The exact incidence of limb ischemia is not known because it is not routinely recorded in the ELSO Registry. In 2 small series, the incidence of ischemia associated with VA ECMO via the CFA ranged from 30% to 50% [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Limb ischemia after common femoral artery cannulation for venoarterial extracorporeal membrane oxygenation: an unresolved problem

Gander

Fisher

Reichstein

et al. 2010

Journal of Pediatric Surgery

100

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Purpose Extracorporeal Life Support Organization Registry data confirm that the number of pediatric patients being supported by extracorporeal membrane oxygenation (ECMO) is increasing. To minimize the potential neurologic effects of carotid artery ligation, the common femoral artery (CFA) is frequently being used for arterial cannulation. The cannula has the potential for obstructing flow to the lower limb, thus increasing ischemia and possible limb loss. We present a single institution’s experience with CFA cannulation for venoarterial (VA) ECMO and ask whether any precannulation variables correlate with the development of significant limb ischemia. Methods We reviewed all pediatric patients who were supported by VA ECMO via CFA cannulation from January 2000 to February 2010. Limb ischemia was the primary variable. The ischemia group was defined as the patients requiring an intervention because of the development of lower extremity ischemia. The patients in the no-ischemia group did not develop significant ischemia. Continuous variables were reported as medians with interquartile ranges and compared using Mann-Whitney U tests. Differences in categorical variables were assessed using χ2 testing (Fisher’s Exact). Statistical significance was assumed at P < .05. Results Twenty-one patients (age, 2–22 years) were cannulated via the CFA for VA ECMO. Significant ischemia requiring intervention (ischemia group) occurred in 11 (52%) of 21. In comparing the 2 groups (ischemia vs no ischemia), no clinical variables predicted the development of ischemia (Table 1). In the ischemia group, 9 (81%) of 11 had a distal perfusion catheter (DPC) placed. Complications of DPC placement included one case of compartment syndrome requiring a fasciotomy and one patient requiring interval toe amputation. Of the 2 patients in the ischemia group who did not have a DPC placed, 1 required a vascular reconstruction of an injured superficial femoral artery and 1 underwent a below-the-knee amputation. Mortality was lower in the ischemia group (27% vs 60%). Conclusions Limb ischemia remains a significant problem, as more than half of our patients developed it. The true incidence may not be known as a 60% mortality in the no-ischemia group could mask subsequent ischemia. Although children are at risk for developing limb ischemia/loss, no variable was predictive of the development of significant limb ischemia in our series. Because of the inability to predict who will develop limb ischemia, early routine placement of a DPC at the time of cannulation may be warranted. However, DPCs do not completely resolve issues around tissue loss and morbidity. Prevention of limb ischemia/loss because of CFA cannulation for VA ECMO continues to be a problem that could benefit from new strategies.

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“…In the recent H1N1 influenza pandemic ECMO support was successfully instigated in children and adults with survival rates of 70% [6,[69][70]. Oseltamivir is the drug of choice in H1N1 new influenza, where alternatives such as inhaled zanamivir or intravenous zanamivir have not been evaluated in critically ill children.…”

Section: Oseltamivirmentioning

confidence: 99%

Pharmacotherapy in Neonatal and Pediatric Extracorporeal Membrane Oxygenation (ECMO)

Wildschut

Ahsman²,

Houmes³

et al. 2012

CDM

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ECMO support is an established life saving therapy for potentially reversible respiratory and/or cardiac failure. Improvement of outcome depends on effective treatment of the primary diagnosis and complications. Adequate drug therapy is important in reaching these goals. Pharmacokinetic and pharmacodynamic data in neonates and older children on ECMO are sparse. Most studies show altered volume of distribution and clearance for the drugs studied. This article gives an overview of the available PK and PD studies in neonates and children on ECMO, suggests possible mechanisms of altered PK and PD and identifies areas of interest for further research.

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Extracorporeal membrane oxygenation for cardiorespiratory failure in four patients with pandemic H1N1 2009 influenza virus and secondary bacterial infection

Cited by 23 publications

References 7 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

Limb ischemia after common femoral artery cannulation for venoarterial extracorporeal membrane oxygenation: an unresolved problem

Pharmacotherapy in Neonatal and Pediatric Extracorporeal Membrane Oxygenation (ECMO)

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