Referral for ECMO during H1N1 in the UK

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Presentation transcript:

Referral for ECMO during H1N1 in the UK Mr Chris Harvey Locum Consultant in Adult and Paediatric ECMO Glenfield 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 Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1) Noah et al JAMA. 2011;306(15):doi:10.1001/jama.2011.1471

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

Use of iNO, HFOV, Prone positioning Cardiac support Renal support 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 Wing 50 by Road 6 by Helicopter 6 with mobile ECMO

ECMO Deaths 10 died on ECMO 6 died off 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?