Is Mobile Extracorporeal Membrane Oxygenation a Safe Tool To Transfer Severely Hypoxaemic Patients in Case of Influenza A/h1n1 Infection?

Nicolas, Jean-Louis;Cambier, Jean-François;Bouhon, S.;Bulpa, Pierre;Evrard, Patrick;et.al.
(2010) 23rd Annual Meeting of the European-Society-of-Intensive-Care-Medicine — Location: Barcelona (Spain) (9.October.2010)

Files

No attached file found for this publication.

Details

Authors
Show more
Abstract
BACKGROUND AND OBJECTIVE. Severe hypoxaemia due to acute respiratory distress syndrome (ARDS) still cause a high mortality rate in spite of the improvement of therapeutic measures. In these severely hypoxaemic patients, Extracorporeal Membrane Oxygenation (ECMO) may be a good additional therapeutic option. However, inter-hospital transfer of patients who need an ECMO can be very dangerous because extreme hypoxaemia or hemodynamic instability may be associated with cerebral hypoxia and death. In this work, we report our experience mobile ECMO system initiated in the referal hospital to secure the transfer, considering 2 groups of patients : first, patients with cardiac failure and ARDS, and secondly, patients with ARDS due to influenza A/H1N1. MATERIAL AND METHODS. Our database was retrospectively analyzed and we report on 18 consecutive patients transferred to our hospital under ECMO assistance. 3 of them required this technique because of cardiocirculatory failure unresponsive to best therapy, 12 others because of ARDS due to various causes and the last 3 because of ARDS specifically due to influenza A/H1N1 pneumonia. Percutaneous veno-venous (VV; n = 14) or veno-arterial (VA; n = 4) ECMO support consisted in a single membrane oxygenator and a centrifugal pump. RESULTS. The transfer of all patients was feasible thanks to a systemic oxygenation and hemodynamic status improvement by the ECMO, after a median door to door transfer time of 73 minutes (range: 26 - 105 minutes) in the first group and 96 minutes (90 - 115 minutes) in the second group. No significant complication was noted during the transfer except a transient loss of electric power supply. In the first group, PaO2/FiO2 improved from 57.2 mmHg (26 - 88 mmHg) to 219 mmHg (47 - 390 mmHg), and from 62.7 mmHg (54-74 mmHg) to 254 mmHg (126-334 mmHg) in the second group, respectively before and after the initiation of ECMO. The mean weaning length for the ECMO system was 7 days in the first group and 19 days in the influenza A/H1N1 group, mean ICU stay duration was 26 days (1 - 110 days) and 29 days (15 - 54 days), while mean hospital stay duration was respectively 31 days (1 - 110 days) and 30 days (17 - 54 days). Four patients died because of brain death due to neurotrauma, pneumonia, candidemia and hemorrhagic abscesses associated to a subarachnoïdal hemorrhage, with a mean period of 5 days after the initiation of the ECMO system. The mortality rate at one month was 26.6% in the first group while all patients suffering from ARDS due to influenza A/H1N1 survived. CONCLUSION. In severely hypoxaemic patients, ECMO support is a safe transfer tool with an experimented team. According to our 100% survival rate in the influenza A/H1N1 pneumonia it should be impossible to die from severe hypoxaemia due to influenza A/H1N1 infection in a primary hospital in Belgium, since there is always a mobile ECMO support and experimented team available.
Affiliations

Citations

  • APA
  • Chicago
  • FWB

Nicolas, J.-L., Cambier, J.-F., Bouhon, S., Bulpa, P., Gonzalez, M., Michaux, I., Installé, E., Dive, A.-M., & Evrard, P. (2010). Is Mobile Extracorporeal Membrane Oxygenation a Safe Tool To Transfer Severely Hypoxaemic Patients in Case of Influenza A/h1n1 Infection? Intensive Care Medicine, 36, S236-S236. https://hdl.handle.net/2078.5/147173 (Original work published 2010)