• Roberto Roncon-Albuquerque, Teresa Honrado, Carla Basílio, Paulo Figueiredo, Paulo Mergulhão, Carlos Alves, Rui Veiga, Salomé Castelo-Branco, Lúcia Paiva, Lurdes Santos, Teresa Oliveira, António Sarmento, and Ana Maria Mota.
• Department of Intensive Care Medicine, Hospital de S.João, Porto, Portugal. rra_jr@yahoo.com
• J Crit Care. 2012 Oct 1;27(5):454-63.

BackgroundTechnological advances improved the practice of "modern" extracorporeal membrane oxygenation (ECMO). In the present report, we describe the experience of a referral ECMO center using portable miniaturized ECMO systems for H1N1-related severe acute respiratory distress syndrome (ARDS).MethodsAn observational study of all patients with H1N1-associated ARDS treated with ECMO in Hospital S. João (Porto, Portugal) between November 2009 and April 2011 was performed. Extracorporeal membrane oxygenation support was established using either ELS or Cardiohelp systems (Maquet-Cardiopulmonary-AG, Hirrlingen, Germany).ResultsTen adult patients with severe ARDS secondary to H1N1 infection (Pao(2)/fraction of inspired oxygen, 69 mm Hg [56-84]; Murray score, 3.5 [3.5-3.8]) were included, and 60% survived to hospital discharge. Five patients were uneventfully transferred on ECMO from referring hospitals to our center by ambulance. Six patients were treated during the first postpandemic influenza season. All patients were treated with oseltamivir, and 1 received in addition zanamivir. Four patients received corticosteroids. Nosocomial infection was the most common complication (40%). Of the 4 deaths, 2 were caused by hemorrhagic shock; 1, by irreversible multiple organ failure; and 1, by refractory septic shock.ConclusionIn our experience, ECMO support was a valuable therapeutic option for H1N1-related severe ARDS. The use of portable miniaturized systems allowed urgent rescue of patients from referring hospitals and safe interhospital and intrahospital transport during ECMO support.Copyright © 2012 Elsevier Inc. All rights reserved.

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