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

Sweden

http://crofsblogs.typepad.com/h5n1/2...swine-flu.html

So, one patient was sent to Denmark, perhaps because they did not have enough beds? Another is not in the ECMO unit, but is on artificial lung apparatus in a separate ICU. Does he mean a vent?

Originally Posted by crofsblogs.typepad.com

Four Swedes are described by medical authorities as having a life-threatening condition following infection with the A/H1N1 swine flu.

Three are being cared for at Karolinska University Hospital in Solna and a fourth has been sent to Åhus in Denmark for treatment.
Two of the critically ill patients are from the Stockholm region, one is from Östergötland, while the fourth is from Gästrikland.
All are described as being under 30-years-old, senior physician Stefan Engkvist told the TT news agency. Two of the patients at Karolinska are being cared for at the ECMO unit and the third has also been put on an artificial lung apparatus but is being kept in a separate intensive care unit.

"There is nothing out of the ordinary with their condition," Stefan Engkvist said but added: "I mean. They have no lung function. That is very serious. But as soon as they receive treatment the condition is stabilized. You feel pretty good when you are on ECMO."

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

That is the first time I heard anyone say "You feel pretty good when you are on ECMO.

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

Uhm, yeah, cause it feels better than dead?

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

Originally Posted by CrunchRN

Uhm, yeah, cause it feels better than dead?

I laughed too when I read this. The doc has a sense of humor?
Breathing is always better than not breathing...

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

Yeah, that one caught me too. Our ECMO patients aren't ALLOWED to feel much of anything! With our tiny people the difference between cannula in and cannula out might be as little as a mm or two so we can't allow them to move much. Our last little guy only had to twitch his sternocleidomastoid and we lost flows altogether, so we roc'd him as often as needed after escalating his fentanyl, ketamine and midazolam infusions. He wasn't feeling much that he could identify...

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

Could be an issue with translation/his english too...

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

Corpus Christi, Texas

http://www.caller.com/news/2009/sep/...hospital-with/

Originally Posted by www.caller.com

Kayla returned home Wednesday after about a month at Driscoll Children’s Hospital. Kayla doesn’t remember much about that month. She was too ill.

Kayla has been a healthy girl, a runner on the school’s cross country team and a former participant in the Beach to Bay Relay Marathon.

Kayla’s parents and her doctors consider her recovery to be a miracle, and some of the credit goes to a machine that takes blood from the body, oxygenates it as your lungs normally would do, and then returns it to the body.

Within six to eight hours of Kayla being on a ventilator at the hospital, Dr. Karl Serrao told her parents she would die unless they used the extracorporeal membrane oxygenation machine, Serrao said.

The machine allowed Kayla’s lungs to start healing, he said.

“The only thing between Kayla and death was that machine,” Serrao said.

Kayla also had a team of more than 20 medical professionals tending to her, Serrao said.

She was admitted at Driscoll Children’s Hospital on July 31 after having flu-like symptoms, shortness of breath, fatigue and headaches.

Her physician had diagnosed her with the flu earlier that week, but it wasn’t clear what type it was, her parents said. Kayla was taking Tamiflu, but she turned weak and tired. The doctor advised her parents to take her to the emergency room.

X-rays showed she had pneumonia, and mucus blocking a lower portion of her lungs, her father, Luis, said. “Things had gotten worse,” he said.

Within 48 hours the family found out she had H1N1 — and a drug-resistant staph infection in her lungs.

That combination can be deadly, Serrao said.

The U.S. Department of Health and Human Services released a summary Thursday finding that most typically healthy children, older than 5 years old who got H1N1, also had bacterial infections.

Kayla will do at-home respiratory treatment four times a day to break up mucus in her lungs. She will continue the treatments for the staph infection for as long as a year, her father said.

(hat tip pfi/crfullmoon)

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

Hmm.. MRSA and H1N1 huh? Sounds like a bad combination... that I'm expecting to see a lot of in the coming months. I have decided to join our ECMO team, although I'm not broadcasting to my coworkers yet. Our training isn't only going to cover ECMO, but also two new types of VADs our hospital will be using and CRRT.

Meanwhile our province has just purchased 106 more ventilators to prepare for the surge... but haven't considered the human resources angle to surge capacity. They're still hell-bent on reducing the workforce (and thus the amount of $$ spent on that frivolously inflated salary line in the budget) and have begun cobbling together an early retirement package. Nothing so lucrative as they've given the executives that were eliminated when we all became one happy health care region though. And while critical care nurses wouldn't be eligible under the current terms of the buy-out, they would look rather stupid if they offered a bunch of buy-outs then hired a hundred ICU nurses, wouldn't they? I hope my coworkers are preparing for mandatory overtime and not being allowed to go home... having arrangements for child care and so on...

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

Update on the Pregnant Scottish Woman Treated in Sweden

http://news.bbc.co.uk/2/hi/uk_news/8257686.stm

She is fine and well and still pregnant! Wow!

Originally Posted by news.bbc.co.uk

A pregnant Scottish woman who had to be flown to Sweden for life-saving treatment for swine flu has spoken for the first time of her ordeal.
Sharon Pentleton told the BBC's Panorama that she was "terrified" after she woke up in a foreign hospital hooked up to a ventilator.
She had to be put on a lung bypass machine to allow her lungs a chance to recover from the illness.
At the time of the outbreak in July, no machines were available in UK.

"I was terrified, I did not realise where I was or anything so, and they were talking strange," she told the BBC's Sophie Raworth. "I was hooked up to all sorts of machines, I don't know...I had a ventilator."

At six months pregnant, Ms Pentleton, of North Ayrshire, originally went to Crosshouse Hospital in Kilmarnock with severe back pain and was initially treated for appendicitis before the diagnosis of swine flu.
After her condition rapidly deteriorated and she slipped into a coma, doctors decided she required the bypass procedure known as extra corporeal membrane oxygenation (ECMO).

The machine takes over the lung function and adds oxygen to the blood, allowing the lungs to recover and medication to treat infection to take hold.
There are only five dedicated adult ECMO beds in Britain, located at Glenfield Hospital in Leicester and none were available when she was struck down.

In Stockholm, she spent almost two weeks hooked up to the machine and had to have a tracheotomy to aid her breathing.
"It was really really horrible, that's the only way I can describe it and then I had all these tubes, couldn't breathe on my own," she said, adding that the true threat to her life only hit her once she was flown home in mid-August and later released from hospital.
"I think it really only sank in when I come home...when I entered the house, that's when I realised exactly what had happened."

Despite now being recovered, Ms Pentleton said she is still fearful of the illness, especially given how sick she became despite not having any previous health issues.

"I'm still quite scared, I don't like to think about it. I realise how close I was to not being here so I still kind of worry about it. And every sight, like wee sniffle or something I'm really panicking."
Ms Pentleton, who is already the mother of a two-year-old daughter, said she still suffers from shortness of breath and worried about giving birth next month.

She also fears for her unborn son.

"They've told me he's still active and he's still growing fine. They told me nothing to worry about with him, because I was worrying about brain damage because everything that I've been through and the medication I've been on.
"But they say there's just a slight chance, they can't tell you 100% but they say its very unlikely that he's been damaged in any way - which is a wee miracle."

Ms Pentleton and her family had words of praise for the medical teams both in Scotland and Sweden who cared for her.
They have launched a fundraising campaign to help raise the money for Scotland to buy and run its own dedicated adult ECMO unit.

(hat tip pfi/aurora)

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

Lung Bypass Saves More Near-Death Swine Flu Cases, Doctors Say

http://www.bloomberg.com/apps/news?p...d=a3B182GF_auk

Originally Posted by www.bloomberg.com

Swine flu patients whose damaged lungs make them unable to breathe may have a better chance of survival if they get an artificial lung technique that’s twice as expensive as standard treatment, researchers said.

Doctors in the U.K. compared a procedure that pumps blood through an artificial lung rather than using mechanical ventilation, when air is blown into the lungs at high pressure. Their study found that 63 percent of the patients in respiratory failure who were selected for the lung bypass technique survived for at least six months without disability, compared with 47 percent assigned to receive conventional ventilation.

The finding, reported today in the medical journal Lancet, suggests the bypass equipment made by companies including Medtronic Inc. could rescue more severe swine flu cases. In Australia’s New South Wales state, 1 in 7 patients critically ill with the new H1N1 strain received the procedure, known as extracorporeal membrane oxygenation or ECMO.

“We have already used ECMO during the first wave of the pandemic with good effect,” said Giles Peek, a surgeon at Glenfield Hospital in Leicester, England, and lead author of the study, in a statement. “We are expecting ECMO to prove an invaluable weapon in the fight against the winter resurgence of the infection.”

Severe swine flu may cause a viral pneumonia resulting in severe respiratory failure in young adults, Peek said. Acute respiratory distress syndrome, a complication of swine flu and other chest infections, is fatal in 34 percent to 58 percent of patients, Peek and colleagues wrote in the study.

In severe cases, influenza can damage the capillaries surrounding the tiny grape-like sacs, known as alveoli, where gas is exchanged through the blood. Damaged alveoli can bleed, causing pulmonary hemorrhage and clots.

$88,000 Machine

ECMO allows the lungs to recover while a machine takes over gas exchange, said Joseph Zwischenberger, head of surgery at the University of Kentucky, who reviewed the Lancet study. The machines cost as much as 60,000 euros ($88,000), said Josef Bogenschütz, Maquet Cardiopulmonary’s chief executive officer.

The Lancet study, the largest randomized medical trial of ECMO in adults, found the procedure resulted in one additional survivor without disability for every six patients treated.

“Everybody is pleased to see that ECMO has a role in critically ill respiratory failure,” Zwischenberger said in a telephone interview today. “The key is patient selection and risk-cost benefit. It’s going to be a delicate balance.”

While fewer than 0.5 percent of swine flu sufferers may need hospitalization, those who do may remain in intensive care for up to three weeks, occupying a bed that could be used for 15 heart bypass patients.

In the Lancet study, average health-care costs per patient were more than twice as high for those selected for treatment by ECMO than for patients sent for conventional management, the researchers said. The average cost for those on ventilators was 33,435 ($55,000) while the average ECMO treatment cost was 73,979 pounds.

Patients in the ECMO group spent about 24 days in intensive-care units, compared with a 13-day stay for patients on mechanical ventilators. Of the 90 patients designated to receive ECMO, 2 died in transit. Of the 68 who received treatment, 43 survived.

“Risks associated with ECMO were small, but the procedure is complex and labor-intensive,” the authors noted. In the medical trial, almost all patients flown to ECMO centers were transported by the Royal Air Force, which isn’t a routine service provider for the U.K.’s National Health Service.

(hat tip pfi/pixie)