Extracorporeal membrane oxygenation for 2009 influenza AH1N1 severe respiratory failure in JapanReport as inadecuate




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Journal of Anesthesia

, Volume 26, Issue 5, pp 650–657

First Online: 23 May 2012Received: 07 March 2012Accepted: 17 April 2012

Abstract

PurposeTo evaluate procedures and outcomes of extracorporeal membrane oxygenation ECMO therapy applied to 2009 influenza AH1N1 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.

KeywordsECMO Influenza Respiratory failure Mortality A comment to this article is available at http:-dx.doi.org-10.1007-s00540-012-1441-3.

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Author: Shinhiro Takeda - Toru Kotani - Satoshi Nakagawa - Shingo Ichiba - Toshiyuki Aokage - Ryoichi Ochiai - Nobuyuki Taenaka - K

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