title: Pandemic flu and the sudden demand for ECMO resources: a mature trauma program can provide surge capacity in acute critical care crises.
abstract: BACKGROUND
  Patients with severe H1N1 pneumonia created a sudden demand for extracorporeal membrane oxygenation (ECMO) capacity. In a single referral center, the established procedures, protocols, and staff of the Level I trauma service were adapted to help manage this nontrauma critical care crisis.
  
  
  METHODS
  When airway pressure release ventilation and high-frequency oscillator ventilation failed, we used standard ECMO circuits and the VDR-4 critical care ventilator. We cannulated patients percutaneously in the intensive care unit and transported them on ECMO. Trauma service resources included a mobile surgical transport team, direct to OR resuscitations, massive transfusion protocols, trauma performance improvement processes, trauma resuscitation nurses, in-house attending doctors, and experienced staff familiar with protocol-driven care.
  
  
  RESULTS
  During an 84-day period, 15 patients with severe H1N1 pneumonia were treated with ECMO. All patients were referred; 10 were transported on ECMO. Patients were aged 34.4 ± 4.1 years (6-58 years); 47% were male, and they had been ventilated 3.5 ± 0.8 days. Pre-ECMO PaO2/FIO2 ratios were 62.3 ± 6.1; ECMO duration was 9.4 ± 1.3 days for survivors; and post-ECMO PaO2/FIO2 ratio was 295.0 ± 35.1. Recovery occurred in 67% and 60% survived to discharge. No patient died of lung failure. Surviving patients were discharged at their neurologic baseline.
  
  
  CONCLUSIONS
  H1N1 created a severe public health challenge for referral centers with ECMO capability. The resources of our trauma service were adapted to this nontrauma critical care crisis without disruption of other hospital services. These H1N1 patients treated with ECMO had a 67% recovery rate and a 60% survival rate. All survivors were discharged to home.
  
  
  METHODS
  Therapeutic/epidemiologic study, level V.
authors.affiliation: ECMO and Trauma Programs at Legacy Emanuel Health Center, Portland Oregon 97227, USA. amichael@lhs.org
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Michaels
authors.forename: Jon G
authors.initials: JG
authors.lastname: Hill
authors.forename: David
authors.initials: D
authors.lastname: Bliss
authors.forename: Bernie P
authors.initials: BP
authors.lastname: Sperley
authors.forename: Brian P
authors.initials: BP
authors.lastname: Young
authors.forename: Peter
authors.initials: P
authors.lastname: Quint
authors.forename: Tanya R
authors.initials: TR
authors.lastname: Shanks
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dalthorp
authors.forename: William B
authors.initials: WB
authors.lastname: Long
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003422:Critical Care / Q000458:organization & administration*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058873:Pandemics / Q000706:statistics & numerical data*; D055872:Surge Capacity / Q000458:organization & administration*; D014193:Trauma Centers / Q000458:organization & administration; D055815:Young Adult