Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) severe respiratory failure in Japan

Shinhiro Takeda,Masaji Nishimura,Kaneyuki Kawamae,Satoshi Nakagawa,Yoshihito Ujike,Nobuyuki Taenaka,Kimitaka Tajimi,Toru Kotani,Toshiyuki Aokage,Shingo Ichiba,Ryoichi Ochiai

doi:10.1007/s00540-012-1402-x

Abstract

PurposeTo evaluate procedures and outcomes of extracorporeal membrane oxygenation (ECMO) therapy applied to 2009 influenza A(H1N1) severe respiratory failure patients in Japan.MethodsThis observational study used database information about adults who received ECMO therapy for H1N1-related severe respiratory failure from April 1, 2010 to March 31, 2011.ResultsFourteen patients from 12 facilities were enrolled. Anti-influenza drugs were used in all cases. Before the start of ECMO, the lowest PaO2/FiO2 was median (interquartile) of 50 (40–55) mmHg, the highest peak inspiratory pressure was 30 (29–35) cmH2O, and mechanical ventilation had been applied for at least 7 days in 5 patients. None of the facilities had extensive experience with ECMO for respiratory failure (6 facilities, no previous experience; 5 facilities, one or two cases annually). The blood drainage cannula was smaller than 20 Fr. in 10 patients (71.4 %). The duration of ECMO was 8.5 (4.0–10.8) days. The duration of each circuit was only 4.0 (3.2–5.3) days, and the ECMO circuit had to be renewed 19 times (10 cases). Thirteen patients (92.9 %) developed adverse events associated with ECMO, such as oxygenator failure, massive bleeding, and disseminated intravascular coagulation. The survival rate was 35.7 % (5 patients).ConclusionECMO therapy for H1N1-related severe respiratory failure in Japan has very poor outcomes, and most patients developed adverse events. However, this result does not refute the effectiveness of ECMO. One possible cause of these poor outcomes is the lack of satisfactory equipment, therapeutic guidelines, and systems for patient transfer to central facilities.

Highlights

The World Health Organization reported individuals infected with a novel swine-origin influenza virus 2009 influenza A(H1N1) in Mexico and the United States in April 2009 [1]
Purpose To evaluate procedures and outcomes of extracorporeal membrane oxygenation (ECMO) therapy applied to 2009 influenza A(H1N1) severe respiratory failure patients in Japan
The study involved adults who received ECMO therapy for severe respiratory failure associated with H1N1 influenza from April 1, 2010 to March 31, 2011

Summary

Introduction

The World Health Organization reported individuals infected with a novel swine-origin influenza virus 2009 influenza A(H1N1) in Mexico and the United States in April 2009 [1]. Serious cases in which oxygenation could not be maintained by conventional mechanical ventilation were managed with extracorporeal membrane oxygenation (ECMO), often yielding excellent outcomes. According to reports from Australia and New Zealand, 68 patients received ECMO therapy during the 2-month period at the height of the epidemic, and the survival rate exceeded 70 % [2]. The Extracorporeal Life Support Organization (ELSO) reported a survival rate of more than 60 % for 323 patients [3]. According to a report from the United Kingdom, treatment outcomes in very severe cases were better when ECMO was applied than when only conventional mechanical ventilation was employed [4]. The ECMO Center Karolinska, Sweden, reported a survival rate of more than 90 % [5]

Methods

Results

Conclusion