title: Critically ill patients with H1N1 influenza A undergoing extracorporeal membrane oxygenation.
abstract: The most common cause of death due to the H1N1 subtype of influenza A virus (swine flu) in the 2009 to 2010 epidemic was severe acute respiratory failure that persisted despite advanced mechanical ventilation strategies. Extracorporeal membrane oxygenation (ECMO) was used as a salvage therapy for patients refractory to traditional treatment. At Legacy Emanuel Hospital, Portland, Oregon, the epidemic resulted in a critical care staffing crisis. Among the 15 patients with H1N1 influenza A treated with ECMO, 4 patients received the therapy simultaneously. The role of ECMO in supporting patients with severe respiratory failure due to H1N1 influenza is described, followed by discussions of the nursing care challenges for each body system. Variations from standards of care, operational considerations regarding staff workload, institutional burden, and emotional wear and tear of the therapy on patients, patients' family members, and the entire health care team are also addressed. Areas for improvement for providing care of the critically ill patient requiring ECMO are highlighted in the conclusion.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bibro
authors.forename: Christine
authors.initials: C
authors.lastname: Lasich
authors.forename: Frank
authors.initials: F
authors.lastname: Rickman
authors.forename: Nichole E
authors.initials: NE
authors.lastname: Foley
authors.forename: Sujen K
authors.initials: SK
authors.lastname: Kunugiyama
authors.forename: Ember
authors.initials: E
authors.lastname: Moore
authors.forename: Amy
authors.initials: A
authors.lastname: O'Brien
authors.forename: Natalie
authors.initials: N
authors.lastname: Sherman
authors.forename: Christine S
authors.initials: CS
authors.lastname: Schulman
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness; D058872:Epidemics; D015199:Extracorporeal Membrane Oxygenation / Q000451:nursing* / Q000523:psychology; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology / Q000451:nursing*; D015401:Nursing Administration Research; D009732:Nursing Care / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care / Q000592:standards; D012131:Respiratory Insufficiency / Q000209:etiology / Q000451:nursing*; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D016526:Workload