title: Portable miniaturized extracorporeal membrane oxygenation systems for H1N1-related severe acute respiratory distress syndrome: a case series.
abstract: BACKGROUND
  Technological advances improved the practice of "modern" extracorporeal membrane oxygenation (ECMO). In the present report, we describe the experience of a referral ECMO center using portable miniaturized ECMO systems for H1N1-related severe acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  An observational study of all patients with H1N1-associated ARDS treated with ECMO in Hospital S. João (Porto, Portugal) between November 2009 and April 2011 was performed. Extracorporeal membrane oxygenation support was established using either ELS or Cardiohelp systems (Maquet-Cardiopulmonary-AG, Hirrlingen, Germany).
  
  
  RESULTS
  Ten adult patients with severe ARDS secondary to H1N1 infection (Pao(2)/fraction of inspired oxygen, 69 mm Hg [56-84]; Murray score, 3.5 [3.5-3.8]) were included, and 60% survived to hospital discharge. Five patients were uneventfully transferred on ECMO from referring hospitals to our center by ambulance. Six patients were treated during the first postpandemic influenza season. All patients were treated with oseltamivir, and 1 received in addition zanamivir. Four patients received corticosteroids. Nosocomial infection was the most common complication (40%). Of the 4 deaths, 2 were caused by hemorrhagic shock; 1, by irreversible multiple organ failure; and 1, by refractory septic shock.
  
  
  CONCLUSIONS
  In our experience, ECMO support was a valuable therapeutic option for H1N1-related severe ARDS. The use of portable miniaturized systems allowed urgent rescue of patients from referring hospitals and safe interhospital and intrahospital transport during ECMO support.
authors.affiliation: Department of Intensive Care Medicine, Hospital de S.João, Porto, Portugal. rra_jr@yahoo.com
authors.forename: Roberto
authors.initials: R
authors.lastname: Roncon-Albuquerque
authors.forename: Carla
authors.initials: C
authors.lastname: Basílio
authors.forename: Paulo
authors.initials: P
authors.lastname: Figueiredo
authors.forename: Sofia
authors.initials: S
authors.lastname: Silva
authors.forename: Paulo
authors.initials: P
authors.lastname: Mergulhão
authors.forename: Carlos
authors.initials: C
authors.lastname: Alves
authors.forename: Rui
authors.initials: R
authors.lastname: Veiga
authors.forename: Salomé
authors.initials: S
authors.lastname: Castelo-Branco
authors.forename: Lúcia
authors.initials: L
authors.lastname: Paiva
authors.forename: Lurdes
authors.initials: L
authors.lastname: Santos
authors.forename: Teresa
authors.initials: T
authors.lastname: Honrado
authors.forename: Celeste
authors.initials: C
authors.lastname: Dias
authors.forename: Teresa
authors.initials: T
authors.lastname: Oliveira
authors.forename: António
authors.initials: A
authors.lastname: Sarmento
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Mota
authors.forename: José Artur
authors.initials: JA
authors.lastname: Paiva
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use; D019095:Point-of-Care Systems; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D053139:Oseltamivir