Not many institutions in the U.S. are set up for ECMO in adults, particularly in the Emergency Department, but there are several small datasets out there indicating it should be a significant part of our arsenal for selected patients. This is a review of ECMO’s use in H1N1 influenza-associated ARDS in England during the “Swine Flu” pandemic.
The authors retrospectively reviewed 80 patients with H1N1 from prospectively collected cohort data, all of whom required critical care for ARDS and were referred for ECMO in the United Kingdom. Through some data calisthenics, these 80 patients were compared to matching subgroups of patients out of 1,756 in the H1N1 critical care cohort. Of the 80 patients referred for ECMO, only 69 actually received it. However, when compared to these 80 patients in an intention-to-treat analysis, there was a significant survival advantage associated with referral to ECMO – approximately 24% mortality in the ECMO-referral group compared to 46-52% in the matched controls, depending on which method they used to identify matched controls.
Not a big stretch to interpret this as a positive treatment association for ECMO in H1N1-associated ARDS. But, I’d still get your flu shot.
“Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)”