Published
I ask this question because twice this week that I am reading of critical swine flu patients having to be transferred to other facilities for treatment with ECMO. I am wondering how many critical cases would require this extreme level of care.
I would not think that many would but, if many people come down with this flu this fall, that would likely increase the number of critical cases, some of which may need this procedure. I am curious about what our capacity is to do this in the US. Surely only the biggest hospitals would be able to treat these cases.
The UK is having quite a strong outbreak of swine flu right now, and it is summer there. Australia, on the other hand, is in the middle of their winter flu season. It is hard to make comparisons between the two different places. At any rate, here is the first report that I came across:
This article describes the transfer of a Scottish woman to a four bed ECMO unit in Sweden. The Swedes came and got her by private jet. Strangely enough, this was the link for a different article on the same case a day ago, but has since been replaced by this latest article. I have no faith that it won't be replaced by yet another topic very soon so I will paste the pertinent info.
www.dailymail.co.uk said:Ms Pentleton is monitored 24-hours a day by an array of equipment and a team of specialists.
She arrived on Thursday evening after Swedish doctors chartered a private jet to fly the two hours to Scotland to pick her up.
Crister Classon, a spokesman for the hospital, said: 'We are happy to help Britain or any other country if they run out of beds.
'It is a normal procedure to help other countries when they need it.
'We have only four beds and we currently have two swine flu patients in them, so there there are presently only two spare beds.'
It is thought a second British patient may be transferred to the unit.
The hospital's Dr Palle Palmer explained that the ECMO machine - similar to a heart and lung machine - was used to 'buy time' for patients. He said people could be kept on the machine for up to two months, but added that most patients did not need ECMO treatment for that long. He said: 'Normally it takes about two weeks, that's the normal treatment. But it is possible to run it for longer.
The Glenfield Hospital in Leicester, where doctors had hoped to treat Miss Pentleton, has the first designated ECMO unit for adults in the UK. But because it was full - with two of its five machines already being used by swine flu patients- medics turned to Stockholm.
ECMO treatment has only recently been accepted into mainstream NHS practice, being regarded as experimental in adults until the completion of a trial six months ago. Seriously sick children have been successfully treated for some time.
Best chance: Scottish health secretary Nicola Sturgeon said it was vital Miss Pentleton was transferred to Sweden
Consultant cardio-thoracic surgeon Mr Richard Firmin director of the ECMO unit in Leicester, said an average of 100 patients a year are treated there and beds could be expanded to 10 if absolutely necessary.
Patients are attached to an ECMO machine while their lungs recover from a variety of conditions, including viral infections and trauma. It involves circulating the patient's blood outside the body and adding oxygen to it artificially, Mr Firmin said 'The circuit is basically an external lung. Anybody who ends up with ECMO is somebody who is at the very severest end of lung failure.'
Patients may need treatment for two to eight weeks, at a cost of £55,000 to £105,000 per patient. Professor David Menon, an intensive care specialist at Cambridge University, said a small minority of swine flu victims who need intensive care have suffered a direct viral attack on their lungs, rather than a secondary infection. The condition called pneumonitis involves destruction of lung tissue.
Thank you Crunch. I don't know that I deserve such praise, but I'll take it!
Alberta child dies from H1N1 complications
EDMONTON-Four more Albertans have died after catching H1N1, including the first child who had chronic underlying health conditions, bringing the provincial total to 38 deaths since the outbreak of the flu in April.
"It is the first child, but this is not unexpected," said Dr. Martin Lavoie, Alberta's deputy chief medical officer of health, referring to a girl from Central Alberta. "Even with seasonal influenza, we see that happening on an annual basis."
In a regular flu season, between 11 and 91 people die directly from the flu or because of complications brought on by the flu. It's not known how many are children.
http://www.edmontonjournal.com/health/Alberta+child+dies+from+H1N1+complications/2220545/story.html
The article says this is our first death, but it's not. I'm not sure how the preceding one was categorized but this is actually #2. I wonder how many more we're in for. I honestly don't recall any peds deaths from "seasonal flu" in this province in the past five years.
Albuquerque, New Mexico
Raymond suffered from vomiting and chest pains on Saturday, so his roommates helped him to the school's teaching hospital emergency room, where he was admitted to the ICU.
With plummeting oxygen levels and blood pressure, Raymond was placd on an ECMO - extracorporeal membrane oxygenation - machine. "They couldn't have done more for us, and Raymond couldn't have been in a better place with better, more dedicated doctors and nurses," his mother, Elaine, said.
Raymond was put on the ECMO machine Sunday afternoon, and died Wednesday night, Nov. 11. "I flew up there on Saturday, thinking that everything would be OK," Ronnie pointed out. When he learned the severity of his son's situation, Ronnie was told by doctors that they had never seen a flu patient's condition turn so bad so quick.
(hat tip pfi/monotreme)
I work in one of the prominent medical facilities in the United States in the CVICU and we are seeing some of the H1N1 patients that are requiring ECMO to survive. Our hospital luckily has large CVICU rooms because the amount of room that the ECMO machines and IV pumps required takes up a large room and we are able to maintain respiratory precautions. Unfortunately, most of the H1N1 patients that were started on ECMO have not survived. One day we were at near compacity for ECMO patients (5 patients). The facility only has 6 ECMO pumps that I am aware of. Staffing of the unit is a nightmare.....there are only 12 trained Rn's for ECMO (some of our unit has been out due to H1N1). I have a feeling the next 6 months are going to be challenging for our unit, due to H1N1 and the expected mutation of this virus!
Haven't posted on the forum in a while, but this thread has been very interesting.(I've already been exposed to a H1N1 positive patient and just finished my course of tamiflu.)
Next month I'm slated to partake in my hospitals ECMO traing program, so wish me luck.
Good for you Ventjock. Be prepared for a learning ladder - forget the curve... it's a ladder. I'm about half way through my practicum, but am on vacation this week. I've also been exposed to many H1N1 positive people, but haven't been on Tamiflu. Seems pointless since I was vaccinated on Oct 27 and my son came down with it on Nov 6 but I didn't.
Unfortunately, most of the H1N1 patients that were started on ECMO have not survived. One day we were at near compacity for ECMO patients (5 patients). The facility only has 6 ECMO pumps that I am aware of. Staffing of the unit is a nightmare.....there are only 12 trained Rn's for ECMO (some of our unit has been out due to H1N1). I have a feeling the next 6 months are going to be challenging for our unit, due to H1N1 and the expected mutation of this virus!
We're 1:3 so far with ours. One successful decannulation, 2 deaths. We have 5 circuits running right now (1/3 of our PICU beds!), which is all the pumps we have, so far as I know. They tell us they've bought more but they haven't shown up yet. Staffing... yeah. We have about 20 RNs and about 18 RTs trained but some of them are no longer active with the team. They've been pressed back into service though. Our sick days have doubled so we're all in the same boat.
Medford, Oregon
http://www.mailtribune.com/apps/pbcs.dll/article?AID=/20091121/NEWS/911210304/-1/news07
...she was placed on an extracorporeal membrane oxygenation machine, which provides oxygen to patients whose heart and lungs are so severely diseased or damaged that they can no longer function.
A preschool teacher, Jacquelyn will be unable to return to work for six months to two years, depending on the progress of her recovery, he said. Because her immune system was severely weakened, Jacquelyn said she will probably not return to teaching preschool but will choose a more controlled environment, perhaps helping her father in his business, in which he leads workshops.
"I'm hoping that with will power, faith and encouragement, it won't take two years," she said.
Our decannulated patient was discharged home today. His parents brought him down for a visit to say goodbye and thank you. I could hardly see his cannulation site on his neck. Amazing.
Oh, and before I forget, only one of the 5 ECMOs we had running this morning is H1N1 related. The others are cardiac.
Omaha, Nebraska
http://www.google.com/hostednews/ap/article/ALeqM5iduExqf9SBhH46t20W8WZ0xE0tQgD9C5F5480
"It was pretty scary knowing that was his blood flowing through those tubes in and out of his body," says Susie Damm of Omaha, Neb., whose 19-year-old son Ryan survived a life-threatening bout after 10 days on ECMO.
"I was one of the people sick and tired of hearing about the swine flu, thinking people were making a big deal of it," she adds. "Now I've had a different look, and I'm very, very thankful" he survived.
No one knows which patients are most likely to benefit-not everyone does. But ECMO is gaining attention after Australian researchers reported that the machines helped during that country's outbreak of what scientists call the 2009 H1N1 flu strain. A voluntary U.S.-based registry counts 107 critically ill swine flu patients recently treated with ECMO, most from this country.
In Omaha, Dr. Jeff DeMare credits the technique with saving Ryan Damm and 7-year-old Tania Romero-Oropeza after both patients' lungs went from clogged to nearly useless in a stunning matter of hours. Tania's care was complicated by a drug-resistant staph infection.
(hat tip pfi/pixie)
Alliston, Ontario
http://www.simcoe.com/article/150466
David Alexander, 53, died on the weekend at Toronto General Hospital. His son John Alexander said doctors were almost 100 per cent certain he had the H1N1 virus.
...doctors determined he needed a procedure called an ecmo.
A few days before entering hospital, he experienced shortness of breath but his family didn't suspect swine flu. It progressed quickly and he died after a week in hospital.
Alexander said his father was healthy and had no underlying health problems.
(hat tip pfi/pixie)
Elmira, New York
Elijah Nist, the 8-year-old Elmira boy stricken three weeks ago with the H1N1 virus, could be removed from life support by Monday or Tuesday, according to his father.
Doctors at Strong Memorial Hospital in Elmira last week rerouted life support machines so that his heart could beat on its own. Doctors are now working to get Elijah's lungs to work on their own without the machines, Jason Nist said.
Elijah is still in a drug-induced state of unconsciousness, but if doctors are able to wean him off life support, they will be able to bring him back to a conscious state, his father said.
(hat tip pfi/pixie)
RI Co-ed on ECMO in North Carolina Hospital
http://www.facebook.com/group.php?gid=183280774868&ref=search&sid=1628323562.2634561355..1
This link at facebook gives us a look at her treatment in hospital. For those of us who don't work with these patients, it sounds so very complicated and amazing. Kudos to the ECMO teams!
http://www.flutrackers.com/forum/showpost.php?p=325775&postcount=1
BARRINGTON, R.I. (WPRI) - A college student from Barrington remains on life support at a North Carolina hospital.
Lillian Chason, a freshman at the University of North Carolina, is fighting the H1N1 flu virus .
According to the facebook group, "Prayers For Lillian," she has been in critical condition at the hospital since November 23.
CrunchRN, ADN, RN
4,556 Posts
Janfrn,
I think you are an incredible mother and a wonderful nurse. Thanks for all your posts here.