Referral for ECMO during H1N1 in the UK

Mr Chris HarveyLocum Consultant in Adult and

Paediatric ECMOGlenfield Hospital, Leicester UK

Started as a Fairytale

22nd July 2009

Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome.Australia and New Zealand Extracorporeal Membrane Oxygenation

(ANZ ECMO) Influenza Investigators, Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, Forrest P, Gattas D, Granger E, Herkes R, Jackson A, McGuinness S, Nair P, Pellegrino V, Pettilä V, Plunkett B, Pye R, Torzillo P, Webb S, Wilson M, Ziegenfuss M.JAMA. 2009 Nov 4;302(17):1888-95. Epub 2009 Oct 12.

Referral to an Extracorporeal Membrane Oxygenation Centerand Mortality Among Patients

With Severe 2009 Influenza A(H1N1)

JAMA. 2011;306(15):doi:10.1001/jama.2011.1471

Noah et al

Referrals - Glenfield Hospital Call Centre

ECMO Patients

• 80 patients transferred for consideration of ECMO

• 69 patients received ECMO• 4 Hospitals

– 51 Glenfield Hospital– 18 Royal Brompton Hospital– 7 Papworth Hospital– 4 Aberdeen Royal Infirmary

• Data collected from SwiFT Study• Web based study with data collected from 192

acute hospitals throughout the UK• Patients 14th July 2009 to 19th February 2010• ECMO Patients matched by

– Individual Matching– Propensity Matching– GenMatch Matching

• Number of days ventilated

• FiO2• PaO2/FiO2 ratio• SOFA score• Age• Pregnancy• BMI• H1N1 Status

• Use of iNO, HFOV, Prone positioning

• Cardiac support• Renal support

12 by Fixed Wing12 by Fixed Wing

6 by Helicopter

50 by Road

6 with mobile ECMO

ECMO Deaths

• 10 died on ECMO– 7 cerebral haemorrhage– 1 cardiac arrest– 1 progressive multi-organ failure– 1 massive pulmonary haemorrhage

• 6 died off ECMO• 4 died after discharge to referring hospital• 2 died after conventional treatment

2010-2011

Swine Flu 2010-2011• 87 patients treated with ECMO survival 74%

– Glenfield Hospital– Brompton Hospital– Guy’s and St Thomas’s– Papworth Hospital– Freeman Hospital– Wythenshawe Hospital– Aberdeen Royal Infirmary– Blackpool Hospital– Golden Jubilee Hospital

During swine flu 332 referrals

Any questions?