Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) severe respiratory failure in Japan

Shinhiro Takeda, Toru Kotani, Satoshi Nakagawa, Shingo Ichiba, Toshiyuki Aokage, Ryoichi Ochiai, Nobuyuki Taenaka, Kaneyuki Kawamae, Masaji Nishimura, Yoshihito Ujike, Kimitaka Tajimi

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Purpose: To evaluate procedures and outcomes of extracorporeal membrane oxygenation (ECMO) therapy applied to 2009 influenza A(H1N1) severe respiratory failure patients in Japan. Methods: This observational study used database information about adults who received ECMO therapy for H1N1-related severe respiratory failure from April 1, 2010 to March 31, 2011. Results: Fourteen patients from 12 facilities were enrolled. Anti-influenza drugs were used in all cases. Before the start of ECMO, the lowest PaO2/FiO2 was median (interquartile) of 50 (40-55) mmHg, the highest peak inspiratory pressure was 30 (29-35) cmH2O, and mechanical ventilation had been applied for at least 7 days in 5 patients. None of the facilities had extensive experience with ECMO for respiratory failure (6 facilities, no previous experience; 5 facilities, one or two cases annually). The blood drainage cannula was smaller than 20 Fr. in 10 patients (71.4 %). The duration of ECMO was 8.5 (4.0-10.8) days. The duration of each circuit was only 4.0 (3.2-5.3) days, and the ECMO circuit had to be renewed 19 times (10 cases). Thirteen patients (92.9 %) developed adverse events associated with ECMO, such as oxygenator failure, massive bleeding, and disseminated intravascular coagulation. The survival rate was 35.7 % (5 patients). Conclusion: ECMO therapy for H1N1-related severe respiratory failure in Japan has very poor outcomes, and most patients developed adverse events. However, this result does not refute the effectiveness of ECMO. One possible cause of these poor outcomes is the lack of satisfactory equipment, therapeutic guidelines, and systems for patient transfer to central facilities.

Original languageEnglish
Pages (from-to)650-657
Number of pages8
JournalJournal of Anesthesia
Volume26
Issue number5
DOIs
Publication statusPublished - Oct 1 2012
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
Respiratory Insufficiency
Human Influenza
Japan
Oxygenators
Patient Transfer
Disseminated Intravascular Coagulation
Therapeutics
Artificial Respiration
Observational Studies
Drainage
Survival Rate
Databases
Guidelines
Hemorrhage
Pressure
Equipment and Supplies

Keywords

  • ECMO
  • Influenza
  • Mortality
  • Respiratory failure

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) severe respiratory failure in Japan. / Takeda, Shinhiro; Kotani, Toru; Nakagawa, Satoshi; Ichiba, Shingo; Aokage, Toshiyuki; Ochiai, Ryoichi; Taenaka, Nobuyuki; Kawamae, Kaneyuki; Nishimura, Masaji; Ujike, Yoshihito; Tajimi, Kimitaka.

In: Journal of Anesthesia, Vol. 26, No. 5, 01.10.2012, p. 650-657.

Research output: Contribution to journalArticle

Takeda, S, Kotani, T, Nakagawa, S, Ichiba, S, Aokage, T, Ochiai, R, Taenaka, N, Kawamae, K, Nishimura, M, Ujike, Y & Tajimi, K 2012, 'Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) severe respiratory failure in Japan', Journal of Anesthesia, vol. 26, no. 5, pp. 650-657. https://doi.org/10.1007/s00540-012-1402-x
Takeda, Shinhiro ; Kotani, Toru ; Nakagawa, Satoshi ; Ichiba, Shingo ; Aokage, Toshiyuki ; Ochiai, Ryoichi ; Taenaka, Nobuyuki ; Kawamae, Kaneyuki ; Nishimura, Masaji ; Ujike, Yoshihito ; Tajimi, Kimitaka. / Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) severe respiratory failure in Japan. In: Journal of Anesthesia. 2012 ; Vol. 26, No. 5. pp. 650-657.
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AU - Kotani, Toru

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AU - Ichiba, Shingo

AU - Aokage, Toshiyuki

AU - Ochiai, Ryoichi

AU - Taenaka, Nobuyuki

AU - Kawamae, Kaneyuki

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N2 - Purpose: To evaluate procedures and outcomes of extracorporeal membrane oxygenation (ECMO) therapy applied to 2009 influenza A(H1N1) severe respiratory failure patients in Japan. Methods: This observational study used database information about adults who received ECMO therapy for H1N1-related severe respiratory failure from April 1, 2010 to March 31, 2011. Results: Fourteen patients from 12 facilities were enrolled. Anti-influenza drugs were used in all cases. Before the start of ECMO, the lowest PaO2/FiO2 was median (interquartile) of 50 (40-55) mmHg, the highest peak inspiratory pressure was 30 (29-35) cmH2O, and mechanical ventilation had been applied for at least 7 days in 5 patients. None of the facilities had extensive experience with ECMO for respiratory failure (6 facilities, no previous experience; 5 facilities, one or two cases annually). The blood drainage cannula was smaller than 20 Fr. in 10 patients (71.4 %). The duration of ECMO was 8.5 (4.0-10.8) days. The duration of each circuit was only 4.0 (3.2-5.3) days, and the ECMO circuit had to be renewed 19 times (10 cases). Thirteen patients (92.9 %) developed adverse events associated with ECMO, such as oxygenator failure, massive bleeding, and disseminated intravascular coagulation. The survival rate was 35.7 % (5 patients). Conclusion: ECMO therapy for H1N1-related severe respiratory failure in Japan has very poor outcomes, and most patients developed adverse events. However, this result does not refute the effectiveness of ECMO. One possible cause of these poor outcomes is the lack of satisfactory equipment, therapeutic guidelines, and systems for patient transfer to central facilities.

AB - Purpose: To evaluate procedures and outcomes of extracorporeal membrane oxygenation (ECMO) therapy applied to 2009 influenza A(H1N1) severe respiratory failure patients in Japan. Methods: This observational study used database information about adults who received ECMO therapy for H1N1-related severe respiratory failure from April 1, 2010 to March 31, 2011. Results: Fourteen patients from 12 facilities were enrolled. Anti-influenza drugs were used in all cases. Before the start of ECMO, the lowest PaO2/FiO2 was median (interquartile) of 50 (40-55) mmHg, the highest peak inspiratory pressure was 30 (29-35) cmH2O, and mechanical ventilation had been applied for at least 7 days in 5 patients. None of the facilities had extensive experience with ECMO for respiratory failure (6 facilities, no previous experience; 5 facilities, one or two cases annually). The blood drainage cannula was smaller than 20 Fr. in 10 patients (71.4 %). The duration of ECMO was 8.5 (4.0-10.8) days. The duration of each circuit was only 4.0 (3.2-5.3) days, and the ECMO circuit had to be renewed 19 times (10 cases). Thirteen patients (92.9 %) developed adverse events associated with ECMO, such as oxygenator failure, massive bleeding, and disseminated intravascular coagulation. The survival rate was 35.7 % (5 patients). Conclusion: ECMO therapy for H1N1-related severe respiratory failure in Japan has very poor outcomes, and most patients developed adverse events. However, this result does not refute the effectiveness of ECMO. One possible cause of these poor outcomes is the lack of satisfactory equipment, therapeutic guidelines, and systems for patient transfer to central facilities.

KW - ECMO

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