Use of extracorporeal life support to support patients with acute respiratory distress syndrome due to H1N1/2009 influenza and other respiratory infections

Abstract

A large proportion of critically ill H1N1/2009 patients with respiratory failure subsequently developed ARDS and, to date, about 400 patients receiving extracorporeal life support (ECLS) have been accounted for globally, with a reported survival rate from 63% to 79%. The survival rates of patients with ARDS due to non-H1N1/2009 infections are similar. There is no definite evidence to suggest that patient outcomes are changed by ECLS, but its use is associated with serious short-term complications.

ECLS relies on an extracorporeal circuit, with extracorporeal membrane oxygenation (ECMO) and pumpless interventional lung assist (ILA) being the two major types employed in ARDS. Both have the potential to correct respiratory failure and related haemodynamic instability. There are only a very limited number of clinical trials to test either and, although ECLS has been used in treating H1N1/2009 patients with ARDS with some success, it should only be offered in the context of clinical trials and in experienced centres.

Keywords

extracorporeal life support influenza ECMO pumpless ILA H1N1 acute respiratory distress syndrome

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References

Jain S. , Kamimoto L. , Bramley AM , et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009 ; 361: 1935-1944.

Louie JK , Acosta M. , Winter K. , et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA 2009; 302: 1896-1902.

Kumar A. , Zarychanski R. , Pinto R. , Cook D. , Marshall J. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA 2009; 302: 1872-1879.

Domínguez-Cherit G. , Lapinsky S. , Macias A. , et al. Critically ill patients with 2009 influenza A(H1N1) in Mexico. JAMA 2009; 302: 1880-1887.

Archer B. , Cohen C. , Naidoo D. , et al. Interim report on pandemic H1N1 influenza virus infections in South Africa, April to October 2009: epidemiology and factors associated with fatal cases. Euro Surveill 2009;14(42): pii: 19369.

Sidebotham D. , McGeorge A. , McGuinness S. , Edwards M. , Willcox T. , Beca J. Extracorporeal membrane oxygenation for treating severe cardiac and respiratory disease in adults: Part 1-overview of extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth 2009; 23: 886-892.

Pollitt A. Subject: Extracorporeal Membrane Oxygenation (ECMO) in adults with potentially reversible respiratory failure (Reference 8894). NHS Specialized Commissioning Group 2007.

Schuerer DJ , Kolovos NS , Boyd KV , Coopersmith CM Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement. Chest 2008; 134: 179-184.

Brogan T. , Thiagarajan R. , Rycus P. , Bartlett R. , Bratton S. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Medicine 2009; 35(12): 2105-2114.

10.

Bein T. , Weber F. , Philipp A. , et al. A new pumpless extracorporeal interventional lung assist in critical hypoxemia/ hypercapnia. Crit Care Med 2006; 34: 1372-1377.

11.

Schmid C. , Philipp A. , Mueller T. , Hilker M. Extracorporeal life support - systems, indications and limitations. Thorac Cardiov Surg 2009; 57: 449-454.

12.

Extracorporeal Life Support Organization. www.elso.med.umich.edu/H1N1.htm (Accessed date 31st March 2010).

13.

Davies A. , Jones D. , Bailey M. , et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA 2009; 302: 1888-1895.

14.

Extracorporeal Life Support Organization (ELSO) ELSO Bibliography (April 2008). http://www.elso.med.umich.edu/Bibliography.html (Accessed date 31st March 2010).

15.

Zapol WM , Snider MT , Hill JD , et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA 1979; 242: 2193-2196.

16.

Morris AH , Wallace CJ , Menlove RL , et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 1994; 149: 295-305.

17.

Peek GJ , Mugford M. , Tiruvoipati R. , et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374: 1351-1363.

18.

Freed DH , Henzler D. , White CW , et al. Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada. Can J Anesth 2010; 57: 240-247.

19.

Buckley E. , Sidebotham D. , McGeorge A. , Roberts S. , Allen SJ , Beca J. Extracorporeal membrane oxygenation for cardiorespiratory failure in four patients with pandemic H1N1 2009 influenza virus and secondary bacterial infection . Br J Anaesth 2010; 104: 326-329.

20.

Suchyta MR , Clemmer TP , Orme JF, Jr. , Morris AH , Elliott CG Increased survival of ARDS patients with severe hypoxemia (ECMO criteria) . Chest 1991; 99: 951-955.

21.

Peek GJ , Moore HM , Moore N. , Sosnowski AW , Firmin RK Extracorporeal membrane oxygenation for adult respiratory failure. Chest 1997; 112: 759-764.

22.

Kolla S. , Awad SS , Rich PB , Schreiner RJ , Hirschl RB , Bartlett RH Extracorporeal life support for 100 adult patients with severe respiratory failure. Ann Surg 1997; 226: 544-564; discussion 65-66.

23.

Lewandowski K. , Rossaint R. , Pappert D. , et al. High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation. Intensive Care Med 1997; 23: 819-835.

24.

Ullrich R. , Lorber C. , Roder G. , et al. Controlled airway pressure therapy, nitric oxide inhalation, prone position, and extracorporeal membrane oxygenation (ECMO) as components of an integrated approach to ARDS. Anesthesiology 1999; 91: 1577-1586.

25.

Linden V. , Palmer K. , Reinhard J. , et al. High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation. Intensive Care Med 2000; 26: 1630-1637.

26.

Mols G. , Loop T. , Geiger K. , Farthmann E. , Benzing A. Extracorporeal membrane oxygenation: a ten-year experience. Am J Surg 2000; 180: 144-154.

27.

Bartlett RH , Roloff DW , Custer JR Extracorporeal life support: The University of Michigan experience. JAMA 2000; 283: 904-908.

28.

Frenckner B. , Palmér P. , Lindén V. Extracorporeal respiratory support and minimally invasive ventilation in severe ARDS. Minerva Anesthesiol 2002; 68: 381-386.

29.

Hemmila MR , Rowe SA , Boules TN , et al. Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg 2004; 240: 595-605.

30.

Gattinoni L. , Pesenti A. , Mascheroni D. , et al. Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 1986; 256: 881-886.

31.

Brunet F. , Belghith M. , Mira JP , et al. Extracorporeal carbon dioxide removal and low-frequency positive-pressure ventilation. Improvement in arterial oxygenation with reduction of risk of pulmonary barotrauma in patients with adult respiratory distress syndrome . Chest 1993; 104: 889-898.

32.

Liebold A. , Reng CM , Philipp A. , Pfeifer M. , Birnbaum DE Pumpless extracorporeal lung assist - experience with the first 20 cases. Eur J Cardiothorac Surg 2000; 17: 608-613.

33.

Florchinger B. , Philipp A. , Klose A. , et al. Pumpless extracorporeal lung assist: a 10-year institutional experience. Ann Thorac Surg 2008; 86: 410-417.

34.

Muellenbach RM , Kredel M. , Wunder C. , et al. Arteriovenous extracorporeal lung assist as integral part of a multimodal treatment concept: a retrospective analysis of 22 patients with ARDS refractory to standard care. Eur J Anaesthesiol 2008; 25: 897-904.

35.

Zimmermann M. , Bein T. , Arlt M. , et al. Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study. Crit Care 2009; 13: R10.

36.

Extracorporeal Life Support Organization (ELSO). ELSO H1N1 Specific Supplements to the ELSO General Guidelines . Ann Arbor, MI (www.elso.med.umich.edu ). November 2009.

37.

Extracorporeal Life Support Organization (ELSO). ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support. Ann Arbor, MI (www.elso.med.umich.edu ). April 2009.

38.

National Institute of Clinical Excellence (NICE). Interventional Procedure Guidance 39, Extracorporeal Membrane Oxygenation (ECMO) in Adult. 2004.

39.

National Institute of Clinical Excellence (NICE). Interventional Procedure Guidance 250. Arteriovenous extracorporeal membrane carbon dioxide removal . January 2008.

40.

Royal College of Anaesthetists’. Pandemic H1N1 2009 Clinical Practice Notes - Managing Critically Ill Cases . 2009.

41.

Davidson T. , Caldwell E. , Curtis J. , Hudson L. , Steinberg K. Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients . JAMA 1999; 281: 354-360.

42.

Chrispin PS , Scotton H. , Rogers J. , Lloyd D. , Ridley SA Short Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire . Anaesthesia 1997; 52: 15-23.

43.

Jones PW , Quirk FH , Baveystock CM The St George’s Respiratory Questionnaire. Respir Med 1991; 85 Suppl B: 25-31.

44.

Folstein MF , Folstein SE , McHugh PR " Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198.

45.

Zigmond A. , Snaith R. The hospital anxiety and depression scale. Acta Psychitr Scand 1983; 67: 361-370.

46.

Robinson BC Validation of a Caregiver Strain Index. J Gerontol 1983; 38: 344-348.

47.

Linden VB , Lidegran MK , Frisen G. , Dahlgren P. , Frenckner BP , Larsen F. ECMO in ARDS: a long-term follow-up study regarding pulmonary morphology and function and health-related quality of life. Acta Anaesthesiol Scand 2009; 53: 489-495.

48.

Chang Y. -S, van Hal SJ , Spencer PM , Gosbell IB , Collett PW Comparison of adult patients hospitalised with pandemic (H1N1) 2009 influenza and seasonal influenza during the ‘PROTECT’ phase of response . Med J Aust 2010; 192: 90-93.