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Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) for Acute Respiratory Distress Syndrome (ARDS) From H1N1 Influenza: Further Evidence Showing Benefit FREE TO VIEW

Saiprasad Narsingam, MD; Troy Sydzyik; Jonathan Kozinn, MD; Michelle Haines, MD
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University of Missouri - Kansas City School of Medicine, Kansas City, MO

Chest. 2015;148(4_MeetingAbstracts):294A. doi:10.1378/chest.2230825
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Over the past decade, there has been increased utilization of Veno-Venous Extracorporeal membrane oxygenation (VV-ECMO) for severe respiratory failure. During the 2009 H1N1 pandemic, ECMO may have been associated with improved survival over conventional ventilation in the most severe cases of ARDS. We hypothesize that VV-ECMO for severe H1N1 induced respiratory failure during the 2013-2014 influenza season will also be associated with improved survival. In this study, we present our experience using VV-ECMO to treat patients with severe ARDS from H1N1 influenza during the 2013-2014 flu season. 2013-2014 is also the first season in North America after the 2009 Influenza pandemic to have H1N1 as the dominant strain.

METHODS: We identified ten adult patients (>18 years of age) who were treated with VV-ECMO at St. Luke’s Hospital of Kansas City and had either confirmed or highly suspected H1N1pdm09 virus induced ARDS during the 2013-14 influenza season.

RESULTS: A total of 10 patients were identified with confirmed or highly-suspected H1N1pdm09 virus induced ARDS who received treatment with VV- ECMO during the 2013-2014 influenza season. 8/10 (80%) patients survived to hospital discharge. The median (IQR) duration of ECMO was 21 (12-36) days. 5/10 (50%) of the patients had a positive Reverse Transcription - Polymerase Chain Reaction (RT- PCR) assay for H1N1pdm09 virus from lower respiratory tract secretions. All ECMO patients were cared for by a critical care nurse under a “single caregiver” model where the bedside nurse was responsible for both managing the ECMO circuit and the nursing needs of the patients.

CONCLUSIONS: Our survival results are on par with nationally available data and provide additional evidence supporting the use of ECMO in severe H1N1pdm09 virus induced ARDS. We further demonstrate that good survival results for patients with H1N1 induced severe ARDS can be achieved under a “single caregiver” “lean” ECMO team model which is less personnel and resource intensive than more traditional models.

CLINICAL IMPLICATIONS: While our study results showing the utillity of VV- ECMO in H1N1 influenza are in agreement and add to the existing evidence from previous studies, we also show that such results can be acheived efficiently with a "single caregiver" team model.

DISCLOSURE: The following authors have nothing to disclose: Saiprasad Narsingam, Troy Sydzyik, Jonathan Kozinn, Michelle Haines

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