title: Extracorporeal membrane oxygenation for severe influenza A (H1N1) acute respiratory distress syndrome: a prospective observational comparative study.
abstract: OBJECTIVE
  To compare characteristics, clinical evolution and outcome in adult patients with influenza A (H1N1) acute respiratory distress syndrome (ARDS) treated with or without extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  A prospective observational study of patients treated in Marseille South Hospital from October 2009 to January 2010 for confirmed influenza A (H1N1)-related ARDS. Clinical features, pulmonary dysfunction and mortality were compared between patients treated with and without ECMO.
  
  
  RESULTS
  Of 18 patients admitted, 6 were treated with veno-venous and 3 with veno-arterial ECMO after median (interquartile, IQR) duration of mechanical ventilation of 10 (6-96) h. Six ECMO were initiated in a referral hospital by a mobile team, a median (IQR) of 3 (2-4) h after phone contact. Before ECMO, patients had severe respiratory failure with median (IQR) PaO₂ to FiO₂ ratio of 52 (50-60) mmHg and PaCO₂ of 85 (69-91) mmHg. Patients treated with or without ECMO had the same hospital mortality rate (56%, 5/9). Duration of ECMO therapy was 9 (4-14) days in survivors and 5 (2-25) days in non-survivors. Early improvement of PaO(2) to FiO₂ ratio was greater in ECMO survivors than non-survivors after ECMO initiation [295 (151-439) versus 131 (106-144) mmHg, p < 0.05]. Haemorrhagic complications occurred in four patients under ECMO, but none required surgical treatment.
  
  
  CONCLUSIONS
  ECMO may be an effective salvage treatment for patients with influenza A (H1N1)-related ARDS presenting rapid refractory respiratory failure, particularly when provided by a mobile team allowing early cannulation prior to transfer to a reference centre.
authors: Service de Réanimation, Hôpital Sainte Marguerite, Hôpitaux Sud, 13274, Marseille Cedex 9, France. antoine.roch@ap-hm.fr
authors: Antoine
authors: A
authors: Roch
authors: Renaud
authors: R
authors: Lepaul-Ercole
authors: Dominique
authors: D
authors: Grisoli
authors: Jacques
authors: J
authors: Bessereau
authors: Olivier
authors: O
authors: Brissy
authors: Matthias
authors: M
authors: Castanier
authors: Stephanie
authors: S
authors: Dizier
authors: Jean-Marie
authors: JM
authors: Forel
authors: Christophe
authors: C
authors: Guervilly
authors: Vlad
authors: V
authors: Gariboldi
authors: Frederic
authors: F
authors: Collart
authors: Pierre
authors: P
authors: Michelet
authors: Gilles
authors: G
authors: Perrin
authors: Remi
authors: R
authors: Charrel
authors: Laurent
authors: L
authors: Papazian
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications* / Q000503:physiopathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D012720:Severity of Illness Index