Extracorporeal Membrane Oxygenation for Pandemic Influenza A(H1N1)―induced Acute Respiratory Distress Syndrome: A Cohort Study and Propensity-matched Analysis

• Published in: American journal of respiratory and critical care medicine Vol. 187; no. 3; pp. 276 - 285
• Main Authors: PHAM, Tai, COMBES, Alain, CLAVEL, Marc, CONSTAN, Adrien, MARIE RICHARD, Jean-Christophe, BRUN-BUISSON, Christian, BROCHARD, Laurent, ROZE, Hadrien, CHEVRET, Sylvie, MERCAT, Alain, ROCH, Antoine, MOURVILLIER, Bruno, ARA-SOMOHANO, Claire, BASTIEN, Olivier, ZOGHEIB, Elie
• Format: Journal Article
• Language: English
• Published: New York, NY American Thoracic Society 01.02.2013
• Subjects: Adult; Age Distribution; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Causality; Cohort analysis; Cohort Studies; Comorbidity; Emergency and intensive respiratory care; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Female; Hospital Mortality; Humans; Influenza; Influenza A Virus, H1N1 Subtype; Influenza, Human - epidemiology; Influenza, Human - therapy; Intensive care; Intensive care medicine; Intensive Care Units - statistics & numerical data; Male; Medical sciences; Mortality; Odds Ratio; Pandemics; Pandemics - statistics & numerical data; Patients; Prospective Studies; Regression analysis; Respiration, Artificial - statistics & numerical data; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - epidemiology; Respiratory Distress Syndrome, Adult - therapy; Risk Factors; Severity of Illness Index; Survival Analysis; Treatment Outcome; Variables; Ventilators; Lung disease; Oxygen; Intensive care; Respiratory disease; H1N1 influenza; acute lung injury; plateau pressure; Infection; Hypoxemia; research network; Viral disease; Cohort study; Respiratory distress; Influenza A; Oxygenation; Resuscitation
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201205-0815OC

Many patients with severe acute respiratory distress syndrome (ARDS) caused by influenza A(H1N1) infection receive extracorporeal membrane oxygenation (ECMO) as a rescue therapy. To analyze factors associated with death in ECMO-treated patients and the influence of ECMO on intensive care unit (ICU) mortality. Data from patients admitted for H1N1-associated ARDS to French ICUs were prospectively collected from 2009 to 2011 through the national REVA registry. We analyzed factors associated with in-ICU death in ECMO recipients, and the potential benefit of ECMO using a propensity score-matched (1:1) cohort analysis. A total of 123 patients received ECMO. By multivariate analysis, increasing values of age, lactate, and plateau pressure under ECMO were associated with death. Of 103 patients receiving ECMO during the first week of mechanical ventilation, 52 could be matched to non-ECMO patients of comparable severity, using a one-to-one matching and using control subjects only once. Mortality did not differ between the two matched cohorts (odds ratio, 1.48; 95% confidence interval, 0.68-3.23; P = 0.32). Interestingly, the 51 ECMO patients who could not be matched were younger, had lower Pa(o(2))/Fi(o(2)) ratio, had higher plateau pressure, but also had a lower ICU mortality rate than the 52 matched ECMO patients (22% vs. 50%; P < 0.01). Under ECMO, an ultraprotective ventilation strategy minimizing plateau pressure may be required to improve outcome. When patients with severe influenza A(H1N1)-related ARDS treated with ECMO were compared with conventionally treated patients, no difference in mortality rates existed. The unmatched, severely hypoxemic, and younger ECMO-treated patients had, however, a lower mortality.