The Use of Extracorporeal Membrane Oxygenation in Severe Adenovirus Pneumonia Complicated by ARDS: A Single-Center Experience

Abstract

SESSION TITLE: Infections in the ICU SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 07:30 AM - 08:30 AM PURPOSE: Acute respiratory distress syndrome (ARDS) in adenovirus pneumonia has a high mortality. Data on extracorporeal membrane oxygenation (ECMO) outcomes in severe adenovirus pneumonia is limited. METHODS: We reviewed case records of patients with severe viral pneumonia requiring ECMO at a single intensive care unit (ICU) between January 2011 and January 2017. Diagnosis was based via viral PCR from endotracheal aspirates or nasopharyngeal specimens. RESULTS: 32 patients with severe viral pneumonia required venovenous ECMO; 8 had adenovirus. Most were male (62.5%), and of Chinese race (62.5%). Between the adenovirus and non-adenovirus groups, there was no difference in baseline characteristics such as age (43.0 years vs 48.0 years; p=0.685), BMI (25.7 kg/m2 vs 25.8; p=0.428), Charlson Comorbidity Index (0 vs 1; p=0.220), APACHE II (21 vs 20; p=0.782), SOFA (7.5 vs 9.0; p=0.815), RESP (4 vs 4; p=0.281) and PRESERVE (2 vs 4; p=0.630). The cohort had only 1 immunocompromised patient (non-adenovirus group). More patients in the adenovirus group received corticosteroids (37.5% vs. 4.2%; p=0.039). The pre-ECMO ICU length of stay (LOS) (4 vs 1 days; p= 0.041), and mechanical ventilation (MV) duration (3.5 vs 1 days; p=0.024) were longer in this group. They also had longer i) ECMO runs (15.5 days vs 7.0 days; p=0.004), ii) MV (20 vs 14.5 days; p=0.009), and iii) ICU LOS (21 vs 15.5 days; p=0.008). There was no difference in hospital LOS (32 vs 28.5 days; p=0.234). Bleeding complications on ECMO were higher in the adenovirus group (75% vs 33.3%; p=0.096), largely contributed by intracranial haemorrhage (accounted for 50% of bleeding in this group). There were 2 (20%) and 5 (20.8%) deaths on ECMO in the adenovirus and non-adenovirus groups respectively. Survival to discharge was comparable (57.1% vs 66.7%; p=0.676). CONCLUSIONS: Survival of ECMO patients with severe adenovirus pneumonia appeared comparable to other viral pneumonias in spite of longer ICU and MV days before ECMO, and more prolonged ECMO runs. An increased risk of intracranial haemorrhage was observed in adenovirus patients. CLINICAL IMPLICATIONS: Severe adenovirus pneumonia requiring ECMO will have significant impact on ICU resource planning and utilisation; further research into management is needed to improve outcomes. DISCLOSURE: The following authors have nothing to disclose: Michelle Kam, Hui Zhong Chai, Ken Junyang Goh, Qiao Li Tan, Duu Wen Sewa, Aik Hau Tan, Melvin Tay, Ghee Chee Phua No Product/Research Disclosure Information