[The use of extracorporeal membrane oxygenation in sustaining pulmonary function patients with influenza A H1N1].
OBJECTIVE
To summarize the clinical method and initial experience of extracorporeal membrane oxygenation (ECMO) supportive treatment in influenza A H1N1 serious patients.


METHODS
In 5 critically ill patients with influenza A H1N1, their arterial oxygen saturation was 0.70 to 0.85 with oxygen concentration (FiO(2)) 1.00 under mechanical ventilation. In these 5 patients, 3 males and 2 females, vein-vein mode ECMO bypass (femoral vein-internal jugular vein) was carried out to assist pulmonary function. The ratio between ECMO oxygen flow and blood flow was 2-1:1, FiO(2) was 0.21 to 1.00, FiO(2) for mechanical ventilation was 0.30 to 0.70, and positive end expiratory pressure (PEEP) was 5-10 cm H(2)O (1 cm H(2)O= 0.098 kPa). Activated coagulation time (ACT) was maintained at 160-250 s. When artery oxygen saturation and artery-venous blood gas became normal on discontinuation of ECMO, ECMO was weaned, and venous cannulas were removed. Mechanical ventilation was continued.


RESULTS
In 5 patients the assisting time of ECMO was 48-330 hours, the mean duration was 178.2 hours. ECMO assisted flow was 2.4-4.0 L/min. The observation time after stoppage of ECMO was 4-24 hours. Four patients were weaned from ECMO, with continuation of assisted respiration successfully. One patient died because the family member gave up hope and the treatment was stopped.


CONCLUSIONS
Vein-vein mode ECMO bypass through femoral vein-internal jugular vein can offer effective aid to pulmonary function in influenza A H1N1 patients who are critically ill. The strategy can win time for the patients to be able to continue mechanical ventilation treatment.
Duan
Da-wei
DW
Tianjin Third Central Hospital of Tianjin Medical University, Tianjin 300170, China.
Li
Tong
T
Qin
Ying-zhi
YZ
Xu
Lei
L
Zhao
Cheng-xiu
CX
Hu
Xiao-min
XM
Wu
Peng
P
Zhang
Qiang
Q
Lang
Yu-heng
YH
D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult