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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 3/2010

01-03-2010 | Case Reports/Case Series

Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada

Authors: Darren H. Freed, MD, PhD, Dietrich Henzler, MD, Chris W. White, MD, Robert Fowler, MD, Ryan Zarychanski, MD, Jamie Hutchison, MD, Rakesh C. Arora, MD, PhD, Rizwan A. Manji, MD, PhD, Jean-Francois Legare, MD, Tanya Drews, MD, Stasa Veroukis, MD, Murray Kesselman, MD, Anne-Marie Guerguerian, MD, Anand Kumar, MD, the Canadian Critical Care Trials Group

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 3/2010

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Abstract

Background

From March to July 2009, influenza A (H1N1) 2009 (H1N1-2009) virus emerged as a major cause of respiratory failure that required mechanical ventilation. A small proportion of patients who had this condition developed severe respiratory failure that was unresponsive to conventional therapeutic interventions. In this report, we describe characteristics, treatment, and outcomes of critically ill patients in Canada who had H1N1-2009 infection and were treated with extracorporeal lung support (ECLS).

Methods

We report the findings of a case series of six patients supported with ECLS who were included in a cohort study of critically ill patients with confirmed H1N1-2009 infection. The patients were treated in Canadian adult and pediatric intensive care units (ICUs) from April 16, 2009 to August 12, 2009. We describe the nested sample treated with ECLS and compare it with the larger sample.

Results

During the study period, 168 patients in Canada were admitted to ICUs for severe respiratory failure due to confirmed H1N1-2009 infection. Due to profound hypoxemia unresponsive to conventional therapeutic interventions, six (3.6%) of these patients were treated with ECLS in four ICUs. Four patients were treated with veno-venous pump-driven extracorporeal membrane oxygenation (vv-ECMO), and two patients were treated with pumpless lung assist (NovaLung iLA). The mean duration of support was 15 days. Four of the six patients survived (66.6%), one of the surviving patients was supported with iLA and the other three surviving patients were supported with ECMO. The two deaths were due to multiorgan failure, which occurred while the patients were on ECLS.

Interpretation

Extracorporeal lung support may be an effective treatment for patients who have H1N1-2009 infection and refractory hypoxemia. Survival of these patients treated with ECLS is similar to that reported for patients who have acute respiratory distress syndrome of other etiologies and are treated with ECMO.
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Metadata
Title
Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada
Authors
Darren H. Freed, MD, PhD
Dietrich Henzler, MD
Chris W. White, MD
Robert Fowler, MD
Ryan Zarychanski, MD
Jamie Hutchison, MD
Rakesh C. Arora, MD, PhD
Rizwan A. Manji, MD, PhD
Jean-Francois Legare, MD
Tanya Drews, MD
Stasa Veroukis, MD
Murray Kesselman, MD
Anne-Marie Guerguerian, MD
Anand Kumar, MD
the Canadian Critical Care Trials Group
Publication date
01-03-2010
Publisher
Springer-Verlag
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 3/2010
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-009-9253-0

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