Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada.
BACKGROUND
From March to July 2009, influenza A (H1N1) 2009 (H1N1-2009) virus emerged as a major cause of respiratory failure that required mechanical ventilation. A small proportion of patients who had this condition developed severe respiratory failure that was unresponsive to conventional therapeutic interventions. In this report, we describe characteristics, treatment, and outcomes of critically ill patients in Canada who had H1N1-2009 infection and were treated with extracorporeal lung support (ECLS).


METHODS
We report the findings of a case series of six patients supported with ECLS who were included in a cohort study of critically ill patients with confirmed H1N1-2009 infection. The patients were treated in Canadian adult and pediatric intensive care units (ICUs) from April 16, 2009 to August 12, 2009. We describe the nested sample treated with ECLS and compare it with the larger sample.


RESULTS
During the study period, 168 patients in Canada were admitted to ICUs for severe respiratory failure due to confirmed H1N1-2009 infection. Due to profound hypoxemia unresponsive to conventional therapeutic interventions, six (3.6%) of these patients were treated with ECLS in four ICUs. Four patients were treated with veno-venous pump-driven extracorporeal membrane oxygenation (vv-ECMO), and two patients were treated with pumpless lung assist (NovaLung iLA). The mean duration of support was 15 days. Four of the six patients survived (66.6%), one of the surviving patients was supported with iLA and the other three surviving patients were supported with ECMO. The two deaths were due to multiorgan failure, which occurred while the patients were on ECLS.


CONCLUSIONS
Extracorporeal lung support may be an effective treatment for patients who have H1N1-2009 infection and refractory hypoxemia. Survival of these patients treated with ECLS is similar to that reported for patients who have acute respiratory distress syndrome of other etiologies and are treated with ECMO.
Freed
Darren H
DH
Surgical Heart Failure Program, Cardiac Sciences Program, St. Boniface General Hospital, CR3030 Asper Clinical Research Building, 369 Tache Ave, Winnipeg, Manitoba R2H 2A6, Canada. dfreed@sbgh.mb.ca
Henzler
Dietrich
D
White
Chris W
CW
Fowler
Robert
R
Zarychanski
Ryan
R
Hutchison
Jamie
J
Arora
Rakesh C
RC
Manji
Rizwan A
RA
Legare
Jean-Francois
JF
Drews
Tanya
T
Veroukis
Stasa
S
Kesselman
Murray
M
Guerguerian
Anne-Marie
AM
Kumar
Anand
A
D000328:Adult; D002170:Canada / Q000453:epidemiology; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D016638:Critical Illness; D004196:Disease Outbreaks; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult