Extracorporeal membrane oxygenation for severe influenza A (H1N1) acute respiratory distress syndrome: a prospective observational comparative study
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To compare characteristics, clinical evolution and outcome in adult patients with influenza A (H1N1) acute respiratory distress syndrome (ARDS) treated with or without extracorporeal membrane oxygenation (ECMO).
A prospective observational study of patients treated in Marseille South Hospital from October 2009 to January 2010 for confirmed influenza A (H1N1)-related ARDS. Clinical features, pulmonary dysfunction and mortality were compared between patients treated with and without ECMO.
Of 18 patients admitted, 6 were treated with veno-venous and 3 with veno-arterial ECMO after median (interquartile, IQR) duration of mechanical ventilation of 10 (6–96) h. Six ECMO were initiated in a referral hospital by a mobile team, a median (IQR) of 3 (2–4) h after phone contact. Before ECMO, patients had severe respiratory failure with median (IQR) PaO2 to FiO2 ratio of 52 (50–60) mmHg and PaCO2 of 85 (69–91) mmHg. Patients treated with or without ECMO had the same hospital mortality rate (56%, 5/9). Duration of ECMO therapy was 9 (4–14) days in survivors and 5 (2–25) days in non-survivors. Early improvement of PaO2 to FiO2 ratio was greater in ECMO survivors than non-survivors after ECMO initiation [295 (151–439) versus 131 (106–144) mmHg, p < 0.05]. Haemorrhagic complications occurred in four patients under ECMO, but none required surgical treatment.
ECMO may be an effective salvage treatment for patients with influenza A (H1N1)-related ARDS presenting rapid refractory respiratory failure, particularly when provided by a mobile team allowing early cannulation prior to transfer to a reference centre.
KeywordsAcute respiratory distress syndrome (ARDS) Extracorporeal membrane oxygenation Influenza A (H1N1) Pneumonia
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