Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

The driver is one-size-fits-all. The size of the circuit is adjusted to the size of the patient. While it is possible to take the technology to the patient, it would mean sending the specialist team (temporarily including a surgeon to perform the cannulation) to the patient too. It makes the most sense to transfer the patient to the technology.

We have six rooms that are large enough to accommodate the bed, the driver (seen in the right foreground of my photo), all the equipment and supplies, the two computer terminals needed for charting and the two or three personnel needed to care for the patient. (Doesn't leave much room for moving around, usually means climbing over or moving things continually.) Four of them are pressurized rooms.

Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

South Hampton, UK

http://www.dailyecho.co.uk/news/4536361./

Transferred for special equipment, most likely means ECMO before she died. According to the link provided by DeepFried RN, the hospital she was sent to does provide it.

http://www.elso.med.umich.edu/CenterByCategory.asp

Originally Posted by www.elso.med.umich.ed

Madelynne Butcher, 18, dies after contracting H1N1 virus
12:30pm Saturday 8th August 2009

Madelynne, of Sholing, Southampton , showed no signs of illness when she headed off on holiday to Tenerife with a friend in June to celebrate finishing her exams.

However, when she returned she was sick and short of breath and her mother took her to see a doctor and then to Southampton General Hospital where she was later sedated.

After two weeks she was transferred to Glenfield Hospital in Leicester to be treated with specialist equipment.
Her mum and dad Alan went to visit her in Leicester on Thursday morning and were told when they arrived that their daughter had died.

The exact cause of her death has yet to be established but Madelynne had been diagnosed as having swine flu by Southampton doctors and had been prescribed the drug Tamiflu.

Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

This One Was Saved

http://www.dailyrecord.co.uk/news/sc...6908-21594312/

Originally Posted by www.dailyrecord.co.uk

A PREGNANT swine flu patient transferred to Sweden for specialist treatment has returned to the UK, it was confirmed today.
Sharon Pentleton, 26, was flown from Scotland to Stockholm because no beds were available in the UK for the rare procedure she required.

Ms Pentleton, from North Ayrshire, had been receiving treatment in the intensive care unit at Crosshouse Hospital in Kilmarnock due to an extreme reaction to the H1N1 virus.

A spokeswoman for Karolinska University Hospital said today that the patient had left their care and returned to the UK.

NHS Ayrshire and Arran recommended that she received a highly-specialised procedure known as extracorporeal membrane oxygenation (Ecmo) for her symptoms of adult respiratory distress syndrome.

The Ecmo treatment involves circulating the ill person's blood outside the body and adding oxygen to it artificially.

It is a relatively new technique which is used when a patient's lungs are functioning very poorly even with ventilation and high levels of oxygen.

The UK has a national Ecmo unit in Leicester but all five beds were being used at the end of July when Ms Pentleton had to be transferred.

Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

http://www.floridatoday.com/article/...006/1086/rss07

Originally Posted by www.floridatoday.com

After fighting for her life the past month, Tiphani Corley has lost her battle against swine flu.

The 19-year-old Rockledge High School graduate died late Saturday night at Shands Hospital in Gainesville. Doctors were using a lung bypass machine and ventilator to keep her alive.

“Her stats just went down. Her organs started shutting down,” said Palm Bay resident Denise Klenotich, a family friend. “She went pretty fast.”

Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

I wonder just which of her "stats" went down? Sorry, I couldn't resist.

Anyone who has any experience with ECMO will tell you that it isn't the miracle everyone thinks it is. It's literally the last ditch. There is nowhere to go from there. And as I think I already said, V-V (veno-venous) ECMO for pulmonary rest is usually a long process and is not nearly as successful as V-A (veno-arterial) ECMO for cardiac rest... and that has a fairly high mortality rate. This story only confirms what has been predicted - the young and healthy will succumb in greater numbers than the old and less firm, at least initially.

Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

I think that adult ECMO will not be widely used for the treatment of flu as the benefits of treatment are limited to a very select patient population. I think my hospital has 4 Centri Mag units that we use for adult ECMO... the most I've seen on our floor at once was 2. Any more than that would completely overwhelm us, the perfusionists, and our cardiothoracic surgeons as well. The resources needed to run ECMO such as blood and blood products would quickly dwindle. The survival rate for ECMO, in general, is not great.

I could see it being used in an otherwise healthy adult with sudden and severe pulmonary compromise after other treatments aren't successful, but I really think the usage will be limited.

My hospital has 650+ beds, 12 of which are the CVICU. There are only a few of us qualified to run adult ECMO (limited to the CVICU). We mostly use A-V ECMO because we are a transplant center. V-V ECMO has only been used a couple of times recently... one patient lived, the other died.

Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

Unfortunately the info janfrn gave on ECMO is only partially accurate. For too many places ECMO is a last ditch effort and when that occurs the results are usually very poor. However, when appropriately implemented, ECMO can be an excellent mode of support and the outcomes can be very good depending on the patient population supported. If you are getting a worse outcome with V-V ECMO than you are with V-A (especially for cardiac rest) then something is very wrong. An organization called ELSO collects data on ECMO patients and there is clearly better survival rates for V-V patients then for cardiac V-A.

I agree that ECMO should not be considered a first line support mode. ECMO is a support mode and not a treatment. If you wait too long to implement the support, then the damage done will not be reversible. Waiting until it is "last ditch effort" is likely to be too late. I noticed from the picture that janfrn posted, the equipment shown there uses pump technology that is nearly 20 years old. There are much newer devices on the market that have improved blood handling characteristics. Not sure if that has anything to do with the reported poor outcomes or not.

ECMO capacity is defintiely limited for all the reasons janfrn stated. It can be very resource intensive and is not a light undertaking by the institution. In the US, we should have the capacity to care for up to 200-300 patients at a time if spread evenly across the country. There are not enough places that provide Adult support though. And rarely do the cases end up being spread out evenly. I know there are processes underway in the ECMO community though to deal with potential pandemic of H1N1 ECMO patients this fall.

Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

Originally Posted by ECMORN

ECMO capacity is defintiely limited for all the reasons janfrn stated. It can be very resource intensive and is not a light undertaking by the institution. In the US, we should have the capacity to care for up to 200-300 patients at a time if spread evenly across the country. There are not enough places that provide Adult support though. And rarely do the cases end up being spread out evenly. I know there are processes underway in the ECMO community though to deal with potential pandemic of H1N1 ECMO patients this fall.

That is interesting. They are trying to plan ahead for a potential need?

Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

Based on the information we are getting from Europe and Australia there is thought that we may see an increase in H1N1 on ECMO. I know of/have received reports on 15 patients in 6 different states on ECMO in the last 6 weeks. Prior to April/May there were no reports in the U.S. of ECMO H1N1 patients. So there are discussions within the ECMO Community to try to be a little proactive and try to be ready. We'll see...

Re: ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

Originally Posted by ECMORN

Unfortunately the info janfrn gave on ECMO is only partially accurate. For too many places ECMO is a last ditch effort and when that occurs the results are usually very poor. However, when appropriately implemented, ECMO can be an excellent mode of support and the outcomes can be very good depending on the patient population supported. If you are getting a worse outcome with V-V ECMO than you are with V-A (especially for cardiac rest) then something is very wrong. An organization called ELSO collects data on ECMO patients and there is clearly better survival rates for V-V patients then for cardiac V-A.

I agree that ECMO should not be considered a first line support mode. ECMO is a support mode and not a treatment. If you wait too long to implement the support, then the damage done will not be reversible. Waiting until it is "last ditch effort" is likely to be too late. I noticed from the picture that janfrn posted, the equipment shown there uses pump technology that is nearly 20 years old. There are much newer devices on the market that have improved blood handling characteristics. Not sure if that has anything to do with the reported poor outcomes or not.

ECMO capacity is defintiely limited for all the reasons janfrn stated. It can be very resource intensive and is not a light undertaking by the institution. In the US, we should have the capacity to care for up to 200-300 patients at a time if spread evenly across the country. There are not enough places that provide Adult support though. And rarely do the cases end up being spread out evenly. I know there are processes underway in the ECMO community though to deal with potential pandemic of H1N1 ECMO patients this fall.

I wonder if UPMC or WPAGH in Pittsburgh have this capacity?