The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks

Patroniti, Nicolò; Zangrillo, Alberto; Pappalardo, Federico; Peris, Adriano; Cianchi, Giovanni; Braschi, A.; Iotti, Giorgio; Arcadipane, Antonio; Panarello, Giovanna; Ranieri, V. Marco; Terragni, Pierpaolo; Antonelli, Massimo; Gattinoni, Luciano; Oleari, Fabrizio; Pesenti, Antonio

doi:10.1007/s00134-011-2301-6

Cited by 336 publications

(268 citation statements)

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“…We report patients with influenza A (H1N1)-associated ARDS referred to the Molinette Hospital (University of Turin) for ECMO in the period from September 2009 to January 2010 [18]. The institutional ethics committee approved data collection and report.…”

Section: Methodsmentioning

confidence: 99%

“…Patients were centralized if conventional ventilation [19], associated to nitric oxide, and/or prone positioning and/or high frequency oscillation resulted in: HbO 2 <85%; oxygenation index>25; PaO 2 /FiO 2 <100 with PEEP≥10 cmH 2 O; hypercapnia and respiratory acidosis with pH<7.25; SvO 2 or SvcO 2 <65% despite Ht>30 and administration of vaso-active drugs [18]. Criteria for initiating ECMO were: oxygenation index>30; PaO 2 /FiO 2 <70 with PEEP≥15 cmH 2 O; pH<7.25 for at least 2 hours [18].…”

Section: Methodsmentioning

confidence: 99%

“…Criteria for initiating ECMO were: oxygenation index>30; PaO 2 /FiO 2 <70 with PEEP≥15 cmH 2 O; pH<7.25 for at least 2 hours [18]. Exclusion criteria for ECMO were: intracranial bleeding and other major contraindication to anticoagulation; previous severe disability; poor prognosis because of the underlying malignancy; mechanical ventilation for longer than 7 days [18].…”

Section: Methodsmentioning

confidence: 99%

“…Unfortunately, available data come from case series [1-5, 18, 52] and only one randomized clinical trial tested the efficacy of ECMO in patients with severe ARDS [53]. Table 4 presents the main ECMO criteria of these studies together with the ECMO criteria proposed by the Extracorporeal Life Support Organization guidelines [15][16][17][18][19][20] 20±0 17 [15][16][17][18][19][20] 12 [11][12][13][14] 15 [13][14][15][16][17][18][19][20] n. …”

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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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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2012

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“…These patients were analyzed retrospectively from a large Italian vvECMO network [2]. Until publication of this paper, inclusion and exclusion criteria for vvECMO treatment were based on expert opinion [3].…”

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confidence: 99%

Predicting mortality while on veno-venous extracorporeal membrane oxygenation

2013

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the authors constructed a very nice model predicting the mortality risk while on veno-venous extra-corporeal membrane oxygenation (vvECMO) in patients with acute respiratory distress syndrome (ARDS) due to H1N1 pneumonia. These patients were analyzed retrospectively from a large Italian vvECMO network [2]. Until publication of this paper, inclusion and exclusion criteria for vvECMO treatment were based on expert opinion [3]. The authors constructed the model from the retrospective data of 60 patients, of which 82 % had H1N1 pneumonia with a survival rate of 71 %. The remaining ARDS patients had a survival rate of 52 %. In another validation set containing 74 patients, the authors tested their model: the area under the curve (AUC) of the receiver operating characteristic (ROC) was 0.69 to predict mortality while on ECMO with a ECMOnet score [4.5 points, with a sensitivity of 51 % and a specificity of 76 %.In our center, we have treated 44 patients with vvECMO: 50 % for bacterial pneumonia, 20 % for viral pneumonia and 27 % for autoimmune pneumonitis disease. The overall survival rate while on vvECMO was 73 %. When applying the ECMOnet score to our patients, the optimal cut-off point (calculated with the Youden index) was an ECMOnet score of 6.5. The AUC with an ECMOnet score [6.5 was exactly 0.69 for predicting mortality while on ECMO with a sensitivity of 50 % and a specificity of 80 % (see Fig. 1). AUC of the oxygenation index and APACHEII was 0.52 and 0.54, respectively. Therefore, it seems that the ECMOnet score is a promising scoring system with a fair specificity in predicting mortality while on vvECMO, although with a higher cut-off point. At least, the ECMOnet score is much better than traditional scoring systems such as oxygenation index or APACHEII. Intensive Care Med

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Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy

Grasselli

Artigas

Cecconi

2020

JAMA

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a patient in his 30s admitted to the intensive care unit (ICU) in Codogno Hospital (Lodi, Lombardy, Italy) tested positive for a new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 . He had a history of atypical pneumonia that was not responding to treatment, but he was not considered at risk for COVID-19 infection. 1 The positive result was immediately reported to the Lombardy health care system and governmental offices. During the next 24 hours, the number of reported positive cases increased to 36. This situation was considered a serious development for several reasons: the patient ("patient 1") was healthy and young; in less than 24 hours, 36 additional cases were identified, without links to patient 1 or previously identified positive cases already in the country; it was not possible to identify with certainty the source of transmission to patient 1 at the time; and, because patient 1 was in the ICU and there were already 36 cases by day 2, chances were that a cluster of unknown magnitude was present and additional spread was likely.On February 21, an emergency task force was formed by the Government of Lombardy and local health authorities to lead the response to the outbreak. This Viewpoint provides a summary of the response of the COVID-19 Lombardy ICU network and a forecast of estimated ICU demand over the coming weeks (projected to March 20, 2020).

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The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks

Abstract: A network organization based on preemptive patient centralization allowed a high survival rate and provided effective and safe referral of patients with severe H1N1-suspected ARDS.

Cited by 336 publications

References 26 publications

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

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

Predicting mortality while on veno-venous extracorporeal membrane oxygenation

Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy

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