Download PDF
Semin Respir Crit Care Med 2011; 32(2): 188-194
DOI: 10.1055/s-0031-1275531
© Thieme Medical Publishers

Extracorporeal Membrane Oxygenation for 2009 Influenza A (H1N1)-Associated Acute Respiratory Distress Syndrome

Alain Combes1 , Vince Pellegrino2
  • 1Service de Réanimation Médicale, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
  • 2Intensive Care Unit, Monash University and Alfred Hospital, Melbourne, Australia
Further Information

Publication History

Publication Date:
19 April 2011 (online)

    Permissions and Reprints

ABSTRACT

The 2009 novel swine-origin influenza A (H1N1) virus was identified in April 2009 in Mexico, and the World Health Organization declared the first phase 6 global influenza pandemic of the century on June 11, 2009. The pandemic spread worldwide in just a few weeks. Most patients diagnosed with H1N1–2009 virus had a self-limited respiratory illness. However, among patients admitted to hospitals, 20 to 33% were hospitalized in intensive care units (ICUs) because of influenza-associated pneumonia and acute respiratory distress syndrome (ARDS). Mortality in patients admitted to the ICU with respiratory failure varied between 17 and 28% and was associated with greater illness severity scores and the need for mechanical ventilation on admission as well as the presence of comorbid conditions and older age. Despite attempts to optimize ventilator settings, some patients developed refractory hypoxemia or hypercapnia and received extracorporeal membrane oxygenation (ECMO) as a rescue therapy. In most of these cases, patients were retrieved from outside major cities and safely transported under ECMO to experienced tertiary centers through semiformal referral networks. However, whether the 25 to 50% mortality observed in the reported ECMO series was affected by the recourse to this technique could not be established.

KEYWORDS

Influenza A virus—H1N1 subtype - intensive care units - respiratory distress syndrome—adult etiology mortality therapy - extracorporeal membrane oxygenation

REFERENCES

  • 1 Dawood F S, Jain S, Finelli L Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans.  N Engl J Med. 2009;  360 (25) 2605-2615
    CrossrefPubMedGoogle Scholar
  • 2 Chowell G, Bertozzi S M, Colchero M A et al.. Severe respiratory disease concurrent with the circulation of H1N1 influenza.  N Engl J Med. 2009;  361 (7) 674-679
    CrossrefPubMedGoogle Scholar
  • 3 Roch A, Lepaul-Ercole R, Grisoli D et al.. Extracorporeal membrane oxygenation for severe influenza A (H1N1) acute respiratory distress syndrome: a prospective observational comparative study.  Intensive Care Med. 2010;  36 (11) 1899-1905
    CrossrefPubMedGoogle Scholar
  • 4 Kumar A, Zarychanski R, Pinto R Canadian Critical Care Trials Group H1N1 Collaborative et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada.  JAMA. 2009;  302 (17) 1872-1879
    CrossrefPubMedGoogle Scholar
  • 5 Louie J K, Acosta M, Jamieson D J, Honein M A. California Pandemic (H1N1) Working Group . Severe 2009 H1N1 influenza in pregnant and postpartum women in California.  N Engl J Med. 2010;  362 (1) 27-35
    CrossrefPubMedGoogle Scholar
  • 6 Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S INER Working Group on Influenza et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico.  N Engl J Med. 2009;  361 (7) 680-689
    CrossrefPubMedGoogle Scholar
  • 7 Webb S A, Pettilä V, Seppelt I ANZIC Influenza Investigators et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand.  N Engl J Med. 2009;  361 (20) 1925-1934
    CrossrefPubMedGoogle Scholar
  • 8 Epidémie de grippe A H1N1 en réanimation: description du registre REVA grippe SRLF. http://revaweb.org/pdf/abstract%20srlf%20004670_FR.pdf Accessed December 15, 2010
    Google Scholar
  • 9 Freed D H, Henzler D, White C W Canadian Critical Care Trials Group et al. Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada.  Can J Anaesth. 2010;  57 (3) 240-247
    CrossrefPubMedGoogle Scholar
  • 10 Davies A, Jones D, Bailey M Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome.  JAMA. 2009;  302 (17) 1888-1895
    CrossrefPubMedGoogle Scholar
  • 11 REVA Organization .SDRA lié à la grippe A (H1N1)-2009, Recommandations pour l'assistance respiratoire. http://www.srlf.org/Data/upload/file/Grippe%20A/reco%20REVA%20SDRA-H1N1.pdf Accessed December 15, 2010
    Google Scholar
  • 12 Peek G J, Mugford M, Tiruvoipati R CESAR trial collaboration et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial.  Lancet. 2009;  374 (9698) 1351-1363
    CrossrefPubMedGoogle Scholar
  • 13 Hubmayr R D, Farmer J C. Should we “rescue” patients with 2009 influenza A(H1N1) and lung injury from conventional mechanical ventilation?.  Chest. 2010;  137 (4) 745-747
    CrossrefPubMedGoogle Scholar
  • 14 Morris A H, Hirshberg E, Miller III R R, Statler K D, Hite R D. Counterpoint: efficacy of extracorporeal membrane oxygenation in 2009 influenza A(H1N1): sufficient evidence?.  Chest. 2010;  138 (4) 778-781, discussion 782–784
    CrossrefPubMedGoogle Scholar
  • 15 Park P K, Dalton H J, Bartlett R H. Point: efficacy of extracorporeal membrane oxygenation in 2009 influenza A(H1N1): sufficient evidence?.  Chest. 2010;  138 (4) 776-778
    CrossrefPubMedGoogle Scholar
  • 16 Bishop J F, Murnane M P, Owen R. Australia's winter with the 2009 pandemic influenza A (H1N1) virus.  N Engl J Med. 2009;  361 (27) 2591-2594
    CrossrefPubMedGoogle Scholar
  • 17 Jain S, Kamimoto L, Bramley A M 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009.  N Engl J Med. 2009;  361 (20) 1935-1944
    CrossrefPubMedGoogle Scholar
  • 18 Nicolay N, Callaghan M A, Domegan L M et al.. Epidemiology, clinical characteristics and resource implications of pandemic (H1N1) 2009 in intensive care units in Ireland.  Crit Care Resusc. 2010;  12 (4) 255-261
    PubMedGoogle Scholar
  • 19 Seppelt I. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study.  BMJ. 2010;  340 c1279
    CrossrefPubMedGoogle Scholar
  • 20 ELSO guidelines. http://www.elso.med.umich.edu/Guidelines.html Accessed December 15, 2010
    Google Scholar
  • 21 NSW Indications for ECMO Referral. http://amwac.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_028.pdf Accessed December15, 2010
    Google Scholar
  • 22 Chenaitia H, Massa H, Toesca R, Michelet P, Auffray J P, Gariboldi V. Mobile cardio-respiratory support in prehospital emergency medicine.  Eur J Emerg Med. 2010 Sep 28;  [Epub ahead of print]
    PubMedGoogle Scholar
  • 23 Clement K C, Fiser R T, Fiser W P et al.. Single-institution experience with interhospital extracorporeal membrane oxygenation transport: a descriptive study.  Pediatr Crit Care Med. 2010;  11 (4) 509-513
    PubMedGoogle Scholar
  • 24 Holzgraefe B, Broomé M, Kalzén H, Konrad D, Palmér K, Frenckner B. Extracorporeal membrane oxygenation for pandemic H1N1 2009 respiratory failure.  Minerva Anestesiol. 2010;  76 (12) 1043-1051
    PubMedGoogle Scholar
  • 25 Jones C, Hommers C, Burns B, Forrest P. ECMO retrieval in NSW and beyond.  Curr Anaesth Crit Care. 2010;  21 (5–6) 282-286
    CrossrefPubMedGoogle Scholar
  • 26 Davies A R, Jones D, Bailey M Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome.  JAMA. 2009;  302 (17) 1888-1895
    CrossrefPubMedGoogle Scholar
  • 27 Buckley E, Sidebotham D, McGeorge A, Roberts S, Allen S J, Beca J. Extracorporeal membrane oxygenation for cardiorespiratory failure in four patients with pandemic H1N1 2009 influenza virus and secondary bacterial infection.  Br J Anaesth. 2010;  104 (3) 326-329
    CrossrefPubMedGoogle Scholar
  • 28 MacLaren G, Cove M, Kofidis T. Central extracorporeal membrane oxygenation for septic shock in an adult with H1N1 influenza.  Ann Thorac Surg. 2010;  90 (3) e34-e35
    CrossrefPubMedGoogle Scholar
  • 29 ELSO H1N1 registry. http://www.elso.med.umich.edu/H1N1Registry.html Accessed December 15, 2010
    Google Scholar
  • 30 Rich P B, Awad S S, Crotti S, Hirschl R B, Bartlett R H, Schreiner R J. A prospective comparison of atrio-femoral and femoro-atrial flow in adult venovenous extracorporeal life support.  J Thorac Cardiovasc Surg. 1998;  116 (4) 628-632
    CrossrefPubMedGoogle Scholar
  • 31 Chiumello D, Mietto C, Berto V et al.. Lung recruitment and PEEP response in ARDS-related H1N1 virus patients [abstract].  Crit Care. 2010;  14 (Suppl 1) 185
    CrossrefPubMedGoogle Scholar
  • 32 Mojoli F, Belliato M, Dell'Avanzo G et al.. Mechanical ventilation during extracorporeal respiratory support in H1N1 patients [abstract].  Intensive Care Med. 2010;  36 S236
    PubMedGoogle Scholar
  • 33 Hui D S, Lee N, Chan P K. Clinical management of pandemic 2009 influenza A(H1N1) infection.  Chest. 2010;  137 (4) 916-925
    CrossrefPubMedGoogle Scholar
  • 34 Lemaitre F, Luyt C E, Roullet-Renoleau F et al.. Oseltamivir carboxylate accumulation in a patient treated by haemodiafiltration and extracorporeal membrane oxygenation.  Intensive Care Med. 2010;  36 (7) 1273-1274
    CrossrefPubMedGoogle Scholar
  • 35 Baz M, Abed Y, Papenburg J, Bouhy X, Hamelin M E, Boivin G. Emergence of oseltamivir-resistant pandemic H1N1 virus during prophylaxis.  N Engl J Med. 2009;  361 (23) 2296-2297
    CrossrefPubMedGoogle Scholar
  • 36 Le Q M, Wertheim H F, Tran N D, van Doorn H R, Nguyen T H, Horby P. Vietnam H1N1 Investigation Team . A community cluster of oseltamivir-resistant cases of 2009 H1N1 influenza.  N Engl J Med. 2010;  362 (1) 86-87
    PubMedGoogle Scholar
  • 37 Kidd I M, Down J, Nastouli E et al.. H1N1 pneumonitis treated with intravenous zanamivir.  Lancet. 2009;  374 (9694) 1036
    CrossrefPubMedGoogle Scholar
  • 38 Gaur A H, Bagga B, Barman S et al.. Intravenous zanamivir for oseltamivir-resistant 2009 H1N1 influenza.  N Engl J Med. 2010;  362 (1) 88-89
    CrossrefPubMedGoogle Scholar
  • 39 Meduri G U, Tolley E A, Chrousos G P, Stentz F. Prolonged methylprednisolone treatment suppresses systemic inflammation in patients with unresolving acute respiratory distress syndrome: evidence for inadequate endogenous glucocorticoid secretion and inflammation-induced immune cell resistance to glucocorticoids.  Am J Respir Crit Care Med. 2002;  165 (7) 983-991
    PubMedGoogle Scholar
  • 40 Meduri G U, Golden E, Freire A X et al.. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial.  Chest. 2007;  131 (4) 954-963
    CrossrefPubMedGoogle Scholar
  • 41 Steinberg K P, Hudson L D, Goodman R B National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network et al. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome.  N Engl J Med. 2006;  354 (16) 1671-1684
    CrossrefPubMedGoogle Scholar
  • 42 Lee N, Allen Chan K C, Hui D S et al.. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients.  J Clin Virol. 2004;  31 (4) 304-309
    CrossrefPubMedGoogle Scholar
  • 43 Lee N, Chan P K, Hui D S et al.. Viral loads and duration of viral shedding in adult patients hospitalized with influenza.  J Infect Dis. 2009;  200 (4) 492-500
    CrossrefPubMedGoogle Scholar
  • 44 Xu T, Qiao J, Zhao L et al.. Effect of dexamethasone on acute respiratory distress syndrome induced by the H5N1 virus in mice.  Eur Respir J. 2009;  33 (4) 852-860
    CrossrefPubMedGoogle Scholar
  • 45 Martin-Loeches I, Lisboa T, Rhodes A ESICM H1N1 Registry Contributors et al. Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection.  Intensive Care Med. 2011;  37 (2) 272-283
    CrossrefPubMedGoogle Scholar
  • 46 La Corticothérapie Améliore-t-elle le Pronostic des Syndromes de Détresse Respiratoire Aigue Associés à une grippe Grave?. http://revaweb.org/pdf/abstractCT-H1N1_SRLF11.pdf Accessed December 15, 2010
    Google Scholar
  • 47 Wiedemann H P, Wheeler A P, Bernard G R National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network et al. Comparison of two fluid-management strategies in acute lung injury.  N Engl J Med. 2006;  354 (24) 2564-2575
    CrossrefPubMedGoogle Scholar

Alain CombesM.D. Ph.D. 

Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié–Salpêtrière

47, Boulevard de l'Hôpital, 75651 Paris, France

Email: alain.combes@psl.aphp.fr

      >