title: Extracorporeal membrane oxygenation support improves survival of patients with Hantavirus cardiopulmonary syndrome refractory to medical treatment.
abstract: OBJECTIVE
  The aim of the study was to evaluate the outcome of extracorporeal membrane oxygenation (ECMO) support in Hantavirus cardiopulmonary syndrome (HCPS) patients with a predicted mortality of 100%, and the complications associated with this treatment modality and different cannulation techniques.
  
  
  METHODS
  A total of 51 patients with refractory HCPS were supported with ECMO between April 1994 and June 2010. They were divided into group A consisting of the 26 patients treated between 1994 and 2000 and group B consisting of 25 patients treated between 2003 and 2010. No patients were treated between September 2000 and December 2003. Patients in group A were intubated when they became hypoxic and placed on ECMO when they became hemodynamically unstable, whereas patients in group B had elective insertion of vascular sheaths and were almost concurrently intubated and placed on ECMO when they decompensated. Cannulation of the femoral vessels was performed percutaneously in 18 (35.3%) patients and with an open technique in 33 (64.7%) patients.
  
  
  RESULTS
  Complications from percutaneous cannulation occurred in 4/18 (22.27%) patients: retroperitoneal hematoma in 2/18 (11.1%) and lower-extremity ischemia in 2/18 (11.1%) patients. Complications from open femoral cannulation occurred in 12/33 (36.3%) patients: bleeding in 10/33 (30.3%) patients and ischemia in 2/33 (6.1%) patients. The overall survival was 66.6% (34 of 51 patients); 56% (14/26) for group A and 80% (20/25) for group B (p = 0.048). There was no difference in mortality regarding the method of cannulation. A trend toward increased mortality in patients with cannulation complications was recognized, but it was not statistically significant. Mortality was not associated with ECMO duration (average 121.7h, range: 5-276h). All survivors recovered and were discharged from the hospital after a mean hospital stay of 19.8 days (range: 10-39 days).
  
  
  CONCLUSIONS
  Two-thirds of 51 HCPS patients with a predicted mortality of 100%, who were supported with ECMO, survived and recovered completely. Survival was significantly higher in the second half of the study. Complications associated with both types of femoral cannulation were associated with a trend toward decreased survival, which was not significant.
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA. jwernly@salud.unm.edu
authors: Jorge A
authors: JA
authors: Wernly
authors: Charles A
authors: CA
authors: Dietl
authors: Cyril Etta
authors: CE
authors: Tabe
authors: Stuart B
authors: SB
authors: Pett
authors: Cameron
authors: C
authors: Crandall
authors: Karen
authors: K
authors: Milligan
authors: Mark R
authors: MR
authors: Crowley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D002648:Child; D004812:Epidemiologic Methods; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D018804:Hantavirus Pulmonary Syndrome / Q000401:mortality / Q000628:therapy*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009516:New Mexico / Q000453:epidemiology; D012187:Retroperitoneal Space; D055815:Young Adult