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

Disasters   (60,310 Views 144 Comments)
by indigo girl indigo girl (New Member) New Member

indigo girl works as a visiting nurse.

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You are reading page 12 of ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?. If you want to start from the beginning Go to First Page.

CrunchRN has 25 years experience as a ADN and works as a Nurse.

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These are all so heart breaking. I feel so badly for their loved ones...........

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NotReady4PrimeTime has 23 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,072 Visitors; 7,339 Posts

I've been away at a conference and just starting to catch up with my allnurses threads...

indigo girl said:
http://www.startribune.com/photos/?c=y&img=1Killer1206_thumb.png

Is this what they are using? Wow! I cannot imagine this either...

We don't have anything like this at our hospital so when we prone patients it's all muscle and great attention to detail. We have proned patients on ECMO, although we really don't like to, for obvious reasons.

indigo girl said:
UPDATE on Post #19, the RI teen in North Carolina

http://www.flutrackers.com/forum/showpost.php?p=326943&postcount=10

Would this type of reaction to a change of the ECMO circuit be expected? I get that this is very complicated.

It happens occasionally, as nursetina03 said, particulary if the patient is on VA-ECMO with little or no native cardiac function. And kids are notorious for not tolerating severe desaturation. We always correct the electrolytes in the circuit when we blood-prime; heparin, THAM, NaHCO3 and CaCl are added to the blood just before the prime is done. It only takes a short time to draw up the meds and pop them into the funnel.

Some Canadian researchers, working in concert with a team from Spain, have identified what might well be the cause of severe H1N1 disease and provide a rapid test for identifying those patients at high risk for it.

http://www.edmontonjournal.com/health/Deadly+side+H1NI+uncovered/2346602/story.html

Canadian scientists believe they have found a hallmark danger signal for potentially fatal H1N1 infection.

Working with Spanish scientists, researchers from the University Health Network in Toronto detected high levels of a molecule in the blood of severe H1N1 patients that may trigger runaway inflammation in the airways, and potentially catastrophic lung damage.

We've moved into a lull on our unit. We successfully decannulated our remaining critical patient just before I went off to my conference. Our minister of health has declared our H1N1 pandemic over and done with, probably because he doesn't read the papers... can't stand to know what people think of him and his management of our health care system I suppose, but that's another topic. When the next wave hits, we could be right back at square one.

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indigo girl works as a visiting nurse.

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janfrn said:

Canadian scientists believe they have found a hallmark danger signal for potentially fatal H1N1 infection.

Working with Spanish scientists, researchers from the University Health Network in Toronto detected high levels of a molecule in the blood of severe H1N1 patients that may trigger runaway inflammation in the airways, and potentially catastrophic lung damage.

We've moved into a lull on our unit. We successfully decannulated our remaining critical patient just before I went off to my conference. Our minister of health has declared our H1N1 pandemic over and done with, probably because he doesn't read the papers... can't stand to know what people think of him and his management of our health care system I suppose, but that's another topic. When the next wave hits, we could be right back at square one.

Yes, that study is fascinating. Here is a link to it: http://ccforum.com/content/pdf/cc8208.pdf

If they can predict in advance who is at risk for cytokine storm, and develop some kind of plan for rapid or prophylactic tx that would be outstanding. I wonder if it wouldn't be helpful for these teams to collaborate with the Vietnamese teams that did some of the early work with patients in cytokine storm from bird flu. I seem to remember that they found that steroids were not helpful in those cases. I really like this sharing and collaborating internationally. WHO has held teleconferences using the info to keep clinicians up to date on what is working, and what doesn't to give our critically ill patients the best chance of recovery right from the beginning of their hospitalizations.

The lull may just be a space of time between waves as you are thinking. No way to know just yet. We do know that eastern Europe is being slammed now, and some of Asia. Not much word out of certain areas of Africa yet, but flu behaves differently in tropical countries. There are still many susceptible hosts in the US, and Europe though I am hearing that many in Canada have taken the vax. Surprisingly, the majority of the US population has not come down with the flu yet, so that still leaves us with a hugh reservoir of unprotected people that could keep this going for some time.

We all know that most folks will come out of this OK, but I suspect still futher occurences of severe disease in random healthy people, and of course, those with prior health problems that have not been vaxed or cannot be vaxed such as kids that are immuno-compromised. This could well take us into spring. Historically, pandemics do continue for some time for the obvious reasons. The 1918 pandemic lasted some 22 months occurring in waves like we are seeing now. The virulence of each wave was different. The other point to consider is that different populations may be targeted in later waves as the virus adapts to humans. I am seeing many more older fatal cases in other countries now. I don't know if it will happen here but it does speak to the need to

vaccinate all possible age groups.

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CrunchRN has 25 years experience as a ADN and works as a Nurse.

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It is so ironic. Here at a major Health Science Center they cannot give away our vaccine. We still have bunches unused.

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NotReady4PrimeTime has 23 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,072 Visitors; 7,339 Posts

Our really severe case received therapeutic plasma exchange daily for about 2 weeks in the most critical part of her illness and I'm thinking that it may well be what saved her life. (It sure made the room crowded, since she was on ECLS and CRRT and was getting TPE! That's a LOT of equipment.)

The local press is reporting that about 40% of our provincial population has been vaccinated. Not quite enough to ensure herd immunity, but better than nothing, I guess. We've had two recently reported deaths, the 16 year old from Calgary and a 35 year-old overweight smoker, also from Calgary. It's not gone, it's just taking a breather! Meanwhile, our vaccination clinics have been closed because, as I said, our minister of health has declared the pandemic is over and is essentially calling it a tempest in a teapot. How disappointed he's going to be when the bug roars back, larger than life, and he's caught without a plan, as usual.

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indigo girl works as a visiting nurse.

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Marseille, France

http://www.flutrackers.com/forum/showpost.php?p=332251&postcount=1

Not a great translation, but we can get that the mother was placed on ECMO. Both mother and child

have survived:

www.flutrackers.com said:

Influenza A: hospitalized for a month, the young mother discovers her child at Christmas

MARSEILLE - A pregnant woman hospitalized in late November in Marseilles when she was diagnosed with a severe form of influenza A was finally able to see her child December 24, after undergoing delivery by emergency Caesarean section and being placed in an artificial coma for several days, "on Tuesday with the AP-HM.

The young woman, aged 22 years and eight months pregnant, suffered a "very serious form of influenza caused by H1N1 virus," explains Assistance Publique-Hôpitaux de Marseille (AP-HM) in a statement.

First sent to hospital in Avignon, she joined the Hospital de la Conception in Marseille where she was placed on a respirator and has undergone emergency, a cesarean delivery.

The premature infant was placed in an incubator a few days while his mother's condition worsened. "She had a very advanced form of syndrome of acute respiratory distress (ARDS) caused by influenza," said the AP-HM.

It was then placed on a respirator bypass connected to a device that purifies the carbon dioxide from his blood and oxygen enrichment.

( ECMO )

After the admission of the young mother in intensive care at the Hôpital Sainte-Marguerite, this assistance was terminated December 9 and the patient was gradually awakened from the coma in which he had been diving.

On December 24, any respiratory support was withdrawn and she was able for the first time, take her child in her arms. She is currently continuing his recovery, said the AP-HM.

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indigo girl works as a visiting nurse.

28,143 Visitors; 5,172 Posts

Madison County, Iowa

http://www.whotv.com/news/who-story-winterset-h1n1-011810,0,5227824.story

A Madison County woman went from being healthy one minute to lying in a hospital bed in critical condition the next. After a nearly two month battle, 22-year-old Krista Hamilton died from complications from the H1N1 flu.

"She had been ill all that week with a cold and a fever. Then that Friday the 13th is when they took her to Mercy," says mom Susan Hamilton. Krista spent about a week in critical condition in Des Moines before doctors transferred her to Iowa City. Her parents never gave up hope or left her side for nearly two months. "She was getting better and they were giving us hope," says Hamilton. Krista suffered a brain hemorrhage and died on January 8th. "It just wasn't meant to be I guess," says her mother. "Didn't get her off the heart lung bypass and wasn't meant to be."

Krista leaves behind a four-month-old son, Jaxson. Her parents say the baby will grow up without his mother, but not his mother's love. "She was gonna be back with him and she wanted to be his mother so badly. She tried…."

(hat tip pfi/KimTT)

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indigo girl works as a visiting nurse.

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Portland, Oregon

http://www.kgw.com/news/local/Swine-Flu-Survivors-Brush-with-Death-83977187.html

Sick since November, he survived but is still hospitalized. I cannot imagine how much his care has cost.

Tom Trautman came down with flu-like symptoms last November. The 45-year-old was initially diagnosed with pneumonia and treated with antibiotics.

But his condition continued to decline. Becky Trautman, Tom's wife, recalled him saying something was wrong; he just "was not getting better" and told her, "I can't breathe."

Days before Christmas Tom wound up in a medically-induced coma, in intensive care and by all accounts, near death.

With few other treatments remaining, Dr. Michaels decided to treat Tom with a risky, labor-intensive method known as extracorporeal membrane oxygenation, or ECMO.

(hat tip pfi/monotreme)

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oramar works as a returned nurse.

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Two weeks ago that Mercy show had an episode where the hospital had only two ECMO units and three kids that needed it. I swear the writers are getting at least some of their material from allnurses.

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NotReady4PrimeTime has 23 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,072 Visitors; 7,339 Posts

I won't comment on how totally hokey that whole story line was... But we HAVE used ECMO to resuscitate a frozen child, back in 2001 (http://www.cbc.ca/canada/story/2001/02/28/baby_erika010228.html). ECMO and the life-saving Bair-Hugger! And the staff at Winnipeg Children's Hospital cut an oxygenator into a CRRT circuit and provided short-term treatment for a neonate with severe lung injury. Now THAT would have made an interesting story line!!(http://www.hsc.mb.ca/press_release22.doc)

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indigo girl works as a visiting nurse.

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Royton, UK

http://www.oldham-chronicle.co.uk/news-features/8/news-headlines/37594/tragic-new-mum-was-so-special?

The 26-year-old gave birth to a beautiful baby boy, Jacob, by emergency Caesarean section days after she fell victim to flu-like symptoms.

He was born on January 8 at the Royal Oldham Hospital. The following day, doctors confirmed to the family Allison had swine flu.

Allison's condition continued to deteriorate and she developed pneumonia. She was heavily sedated and put on a ventilator when she became unable to breathe.

Her consultant tracked down a special ECMO machine, which oxygenates the blood, at the Royal Brampton Hospital in Chelsea. The young mum was transferred by ambulance. After six weeks of keeping a bedside vigil, Gareth along with Allison's parents Julie and David Astley, were told her organs had begun to fail. She'd lost her fight for life.

(hat tip pfi/pixie)

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indigo girl works as a visiting nurse.

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The UK

HPA - HPA National Influenza Report

This is now, 2010, not last year...

Influenza activity is increasing; GP consultation rates are now above baseline levels in England. Outbreaks and severe cases, mainly in people aged under 65 years, continue to be reported. Influenza A H1N1 (2009) and B are the predominant circulating viruses with few, sporadic A (H3N2) viruses detected. The H1N1 (2009) virus strain is virologically and epidemiologically similar to that seen during the pandemic. The virus strains circulating are well matched to the current influenza vaccine and very little antiviral resistance has been detected. The HPA expects to see continued elevated influenza activity for several weeks.

Severe cases requiring ICU/ECMO admission have been reported. From week 36, 17 deaths associated with influenza infection have been reported. The majority of severe cases reported are aged under 65.

HPA - HPA National Influenza Report

There have been reports of influenza hospitalisations and ICU admissions across the UK. Twenty-two H1N1 (2009) patients have been referred for ECMO up until 15 December 2010. Of these, 17 have received ECMO. All cases receiving ECMO have been adults under 65 years in age (median=39 years, IQR 35-45 years). Four of the 17 (23.5%) cases were pregnant.

(hat tip flutrackers/ironorehopper)

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