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Extracorporeal membrane oxygenation for influenza-associated acute respiratory distress syndrome.
Thorac Cardiovasc Surg. 2013 Sep; 61(6):516-21.TC

Abstract

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) therapy for patients with influenza A (H1N1)-related acute respiratory distress syndrome (ARDS) has been described once all other therapeutic options have been exhausted. The current report reviews our institutional experience and lessons learned in 18 consecutive patients.

METHODS

Between December 2009 and March 2011, 18 patients underwent ECMO therapy for severe H1N1-related ARDS. Mean age was 40 ± 18 years (range 4-67 years). Ten patients (56%) received venoarterial cannulation (v-a ECMO) while venovenous cannulation (v-v ECMO) was initiated in the remaining patients (n = 8, 44%). To identify risk factors of adverse outcome, univariate analysis was performed for clinical parameters.

RESULTS

Successful ECMO weaning was possible in 44% (n = 8) of patients and overall mortality was 61% (n = 11). Seven of the eight patients who could be successfully weaned from ECMO support fully recovered. Survival within the v-a ECMO group (60%) was superior to the v-v ECMO group (13%; p = 0.06). Two patients (11%) required re-exploration of the axillary artery cannulation site. No further adverse events associated with ECMO implantation occurred. Outcome was better when the time of severe deoxygenation (Pao2 < 70 mm Hg) despite maximally invasive respiratory support to ECMO implantation was less than 6 hours (odds ratio: 2.4; p = 0.05).

CONCLUSIONS

ARDS associated with H1N1 remains a devastating clinical picture. In our hands, ECMO support offered survival to 40% of patients with otherwise fatal prognosis. While v-v ECMO remains the method of choice for patients suffering an isolated ARDS in the setting of stable hemodynamic conditions, v-a ECMO may be considered if the clinical picture of ARDS is aggravated by systemic inflammatory response syndrome with the requirement of high dose vasopressor support.

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Publisher Full Text

Authors+Show Affiliations

Papadopoulos N
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Frankfurt am Main, Germany.
Ahmad Ael-S
No affiliation info available
Marinos S
No affiliation info available
Moritz A
No affiliation info available
Zierer A
No affiliation info available

MeSH

AdolescentAdultAgedChi-Square DistributionChildChild, PreschoolExtracorporeal Membrane OxygenationFemaleHemodynamicsHumansInfluenza A Virus, H1N1 SubtypeInfluenza, HumanKaplan-Meier EstimateMaleMiddle AgedOdds RatioPatient SelectionRespiratory Distress SyndromeRisk FactorsTime FactorsTreatment OutcomeYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23225509

Citation

Papadopoulos, Nestoras, et al. "Extracorporeal Membrane Oxygenation for Influenza-associated Acute Respiratory Distress Syndrome." The Thoracic and Cardiovascular Surgeon, vol. 61, no. 6, 2013, pp. 516-21.
Papadopoulos N, Ahmad Ael-S, Marinos S, et al. Extracorporeal membrane oxygenation for influenza-associated acute respiratory distress syndrome. Thorac Cardiovasc Surg. 2013;61(6):516-21.
Papadopoulos, N., Ahmad, A. e. l. -. S., Marinos, S., Moritz, A., & Zierer, A. (2013). Extracorporeal membrane oxygenation for influenza-associated acute respiratory distress syndrome. The Thoracic and Cardiovascular Surgeon, 61(6), 516-21. https://doi.org/10.1055/s-0032-1330923
Papadopoulos N, et al. Extracorporeal Membrane Oxygenation for Influenza-associated Acute Respiratory Distress Syndrome. Thorac Cardiovasc Surg. 2013;61(6):516-21. PubMed PMID: 23225509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extracorporeal membrane oxygenation for influenza-associated acute respiratory distress syndrome. AU - Papadopoulos,Nestoras, AU - Ahmad,Ali El-Sayed, AU - Marinos,Spiros, AU - Moritz,Anton, AU - Zierer,Andreas, Y1 - 2012/12/06/ PY - 2012/12/11/entrez PY - 2012/12/12/pubmed PY - 2014/4/16/medline SP - 516 EP - 21 JF - The Thoracic and cardiovascular surgeon JO - Thorac Cardiovasc Surg VL - 61 IS - 6 N2 - BACKGROUND: Extracorporeal membrane oxygenation (ECMO) therapy for patients with influenza A (H1N1)-related acute respiratory distress syndrome (ARDS) has been described once all other therapeutic options have been exhausted. The current report reviews our institutional experience and lessons learned in 18 consecutive patients. METHODS: Between December 2009 and March 2011, 18 patients underwent ECMO therapy for severe H1N1-related ARDS. Mean age was 40 ± 18 years (range 4-67 years). Ten patients (56%) received venoarterial cannulation (v-a ECMO) while venovenous cannulation (v-v ECMO) was initiated in the remaining patients (n = 8, 44%). To identify risk factors of adverse outcome, univariate analysis was performed for clinical parameters. RESULTS: Successful ECMO weaning was possible in 44% (n = 8) of patients and overall mortality was 61% (n = 11). Seven of the eight patients who could be successfully weaned from ECMO support fully recovered. Survival within the v-a ECMO group (60%) was superior to the v-v ECMO group (13%; p = 0.06). Two patients (11%) required re-exploration of the axillary artery cannulation site. No further adverse events associated with ECMO implantation occurred. Outcome was better when the time of severe deoxygenation (Pao2 < 70 mm Hg) despite maximally invasive respiratory support to ECMO implantation was less than 6 hours (odds ratio: 2.4; p = 0.05). CONCLUSIONS: ARDS associated with H1N1 remains a devastating clinical picture. In our hands, ECMO support offered survival to 40% of patients with otherwise fatal prognosis. While v-v ECMO remains the method of choice for patients suffering an isolated ARDS in the setting of stable hemodynamic conditions, v-a ECMO may be considered if the clinical picture of ARDS is aggravated by systemic inflammatory response syndrome with the requirement of high dose vasopressor support. SN - 1439-1902 UR - https://www.unboundmedicine.com/medline/citation/23225509/Extracorporeal_membrane_oxygenation_for_influenza_associated_acute_respiratory_distress_syndrome_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0032-1330923 DB - PRIME DP - Unbound Medicine ER -