title: Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome.
abstract: OBJECTIVE
  The purposes of this study are to evaluate the outcome of extracorporeal membrane oxygenation support in a subgroup of patients with Hantavirus cardiopulmonary syndrome who had a predicted mortality of 100% and to assess the complications associated with this treatment modality and with different cannulation techniques.
  
  
  METHODS
  Thirty-eight patients with severe Hantavirus cardiopulmonary syndrome were supported with extracorporeal membrane oxygenation between April 1994 and June 2006. Cannulation of the femoral vessels was performed on an emergency basis by a percutaneous approach in 15 (39.5%) and by an open technique in 23 (60.5%) patients. Duration of extracorporeal membrane oxygenation averaged 132 hours (range: 5-276 hours).
  
  
  RESULTS
  Complications from percutaneous cannulation occurred in 4 (26.6%) of 15 patients: retroperitoneal hematoma in 2 (13.3%) and lower extremity ischemia in 2 (13.3%) patients, which resolved after insertion of a distal perfusion cannula. Complications from open femoral cannulation occurred in 8 (34.8%) of 23 patients: severe bleeding in 7 (30.4%) patients and lower extremity ischemia in 1 (4.3%) patient who required a leg amputation. The overall survival was 60.5% (23/38 patients). Six (40%) of the 15 patients cannulated percutaneously and 9 (39.1%) of 23 patients who had open cannulation died. All survivors recovered completely and were discharged from the hospital after a mean hospital stay of 20.8 days (range: 10-39 days).
  
  
  CONCLUSIONS
  Almost two thirds of the patients with severe Hantavirus cardiopulmonary syndrome who were supported with extracorporeal circulation survived and recovered completely. The complications associated with both types of femoral cannulation may be attributed to the fact that all patients were in shock or in full cardiac arrest, and the procedure had to be done expeditiously. Earlier institution of extracorporeal membrane oxygenation may decrease the complication rates and improve the overall survival.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM 87131-0001, USA. cdietl@comcast.net
authors.forename: Charles A
authors.initials: CA
authors.lastname: Dietl
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Wernly
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Pett
authors.forename: Said F
authors.initials: SF
authors.lastname: Yassin
authors.forename: José P
authors.initials: JP
authors.lastname: Sterling
authors.forename: Robert
authors.initials: R
authors.lastname: Dragan
authors.forename: Karen
authors.initials: K
authors.lastname: Milligan
authors.forename: Mark R
authors.initials: MR
authors.lastname: Crowley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D018804:Hantavirus Pulmonary Syndrome / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis