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

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by indigo girl indigo girl (New Member) New Member

indigo girl works as a visiting nurse.

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You are reading page 7 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.

indigo girl works as a visiting nurse.

28,143 Visitors; 5,172 Posts

Tarant, Texas

http://www.star-telegram.com/804/story/1692351.html

Andrea Samples knew that her daughter's flu wasn't typical when the 15-year-old's hands and feet went numb.

Jessica Samples' flu started Sept. 26 with a backache. As it grew worse, the Timber Creek High School sophomore had labored breathing and became restless. Eventually, after being seen twice by doctors at a clinic and emergency room in Northeast Tarrant County, she was admitted to Cook Children's Medical Center.

She had the H1N1 virus-swine flu-and relatives worried that she wouldn't survive.

As a last resort, doctors put her on a machine that oxygenated her blood.

Now, 16 days after entering the hospital, she is recovering and is expected to be released Sunday.

Fluid had collected around Jessica's heart, Thompson said. She had no pulse in her arms and legs and had poor blood flow. The extracorporeal membrane oxygenation machine let Jessica's to rest so her body could fight the illness.

"Without the ECMO, our thought is that she would have died," Thompson said.

(hat tip flutrackers/shiloh)

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indigo girl works as a visiting nurse.

28,143 Visitors; 5,172 Posts

Edmond, Oklahoma

I think that they are saying this child was on ECMO without really saying it...

http://www.newsok.com/article/3409854?searched=Tony%20Estlinbaum%20&custom_click=search

After lying in a hospital bed for weeks recovering from swine flu, 10-year-old Tony Estlinbaum was ready to try standing without help Friday.

Tony was a healthy boy with no history of asthma or other medical conditions, but he had severe complications with his lungs because of H1N1, McMichael said.

Estlinbaum said he wants to draw attention to Tony's case so parents will take the flu seriously, especially if their children have problems breathing along with flu symptoms. He said Tony felt fine Sept. 12 when he played in his first tackle football game, but had a headache that evening. On Sept. 13, he had some flu-like symptoms and trouble breathing. After a visit to the emergency room, Tony ended up at The Children's Hospital at OU Medical Center with a collapsed lung.

"That's when the battle truly started," Estlinbaum said.

Doctors eventually put Tony into a medically induced coma and on a respiratory support system that provides oxygen to patients whose heart and lungs are damaged. Now, the therapy Tony will do at The Children's Center will help clear his lungs further and help him to work toward full recovery, McMichael said.

(hat tip pfi/pixie)

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Multicollinearity has 4 years experience.

27,437 Visitors; 3,119 Posts

http://www.azcentral.com/news/articles/2009/10/18/20091018fluvigil-childrens1018.html

Phoenix Children's Hospital was swamped last week with about a dozen children battling suspected cases of swine flu. Three of those children needed a type of life-support machine.

"This is shockingly unusual," said Dr. Heidi Dalton, a pediatric physician.

Dalton said most swine-flu patients are able to shake off the illness with their own immune system or standard treatment.

But a handful of cases may require extreme measures, such as a procedure called extracorporeal membrane oxygenation, in which a machine oxygenates blood in patients who are suffering from heart or lung disease.

Of the three such cases that Phoenix Children's has handled in the past week, each patient had an underlying medical condition that may have caused increased susceptibility to serious illness.

Two of the three patients were removed from the machines successfully. A 20-month-old girl was still being treated with one of the machines as of Friday.

Phoenix Children's estimates it cannot treat more than four patients at once with the machines. "We were so stressed this week," Dalton said. "We're pretty nervous about this. The regular flu season hasn't even hit yet."

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

16 Articles; 71,071 Visitors; 7,339 Posts

Thanks for keeping this thread going. I know there will be more stories as time goes by.

I just learned that our unit has been designated a Center of Excellence in Life Support by ELSO for a period of two years. It's pretty rarified company... Cincinnati Children's, Wake Forest, the Karolinska Institute, Duke, CHOP, UCSF, Rainbow Babies and Children's... wow!

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indigo girl works as a visiting nurse.

28,143 Visitors; 5,172 Posts

Thanks for keeping this thread going. I know there will be more stories as time goes by.

I just learned that our unit has been designated a Center of Excellence in Life Support by ELSO for a period of two years. It's pretty rarified company... Cincinnati Children's, Wake Forest, the Karolinska Institute, Duke, CHOP, UCSF, Rainbow Babies and Children's... wow!

Congratulations! And, good luck. I think that you will be busy...

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

1 Follower; 29,999 Visitors; 4,177 Posts

I am monitoring this thread with interest and concern....... thanks for all the enlightening posts.

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indigo girl works as a visiting nurse.

28,143 Visitors; 5,172 Posts

Portland, Oregon

http://kdrv.com/page/146165

A Southern Oregon man and woman are still in critical condition in a Portland hospital after developing complications from the H1N1 virus.

The two patients were transferred to Portland Wednesday to receive rare respiratory treatments.

A special surgical team from Legacy Emmanuel Medical Center in Portland flew in to the Rogue Valley Medical Center Tuesday night on a Blackhawk helicopter.

One of the patients, Zachary Painter of Grants Pass, is in his 30s. Painter and Jacquelyn Cordero were transferred to Portland by ambulance. They were taken to undergo a lung bypass procedure called an ECMO, which cannot be done at RVMC.

(hat tip pfi/monotreme)

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WalkieTalkie works as a RN.

7,068 Visitors; 674 Posts

We got our first patient on ECMO for H1N1 (probable) related ARDS last night. I'll give you guys some background info:

Patient is in his early 20s. No significant PMH except for some slight MR and what mom called "developmental delays." Patient does not have any known chronic medical conditions, and all anatomical structures are normal. Patient presented at outside facility with flu-like symptoms (sore throat, cough, diarrhea, etc) and admitted to said outside facility.

The patient rapidly deteriorated at the outside facility and was life flighted to us, intubated en route, and progressed into ARDS. Patient had started with normal vent settings and then ended up on 100% FiO2 and 20 of PEEP, with sats in the low 80s. ECMO was initiated within a day of him being transferred to us. Patient was cannulated in the room, so I do not believe that he had an extreme period of hypoxemia after normal interventions had failed.

Tamiflu was started immediately upon admission at our hospital (not sure what the other hospital had done). Patient is also being covered on broad spectrum abx, including vanco. So far all blood and sputum cultures are negative. The patient has had two H1N1 neg rapid influenza tests at the previous hospital, and one at ours. The PCR test was not performed due to the likelihood that he has H1N1, and the fact that the turn around time on PCR tests at our facility is a couple of days. It would not change the way we are treating him anyway.

It is interesting to note that the patient had been placed on a propofol drip. I noticed that the patient had been becoming bradycardic during the night. I couldn't think of a good reason for the bradycardia, and I was thinking of possible propofol infusion sydrome, even though the patient had not been on the gtt very long. We did start the patient on some low-dose dopamine, but the heart rate did not really seem to respond to it.

Our hospital does baseline daily CKs, lactic acids, and triglyceride levels to detect early PRIS. Well, guess what? The patient's CK (initially elevated due to probable myocarditis) went from 600-something yesterday, to 1500-something this morning. In addition to that, his triglycerides went from a baseline of 100-something to 588 this morning! Yikes! We couldn't get the propofol shut off quickly enough!

Overall, this patient looks worse this morning than yesterday. His chest x-ray is more whited out, and to top things off, he had a 10 second new-onset seizure right before change of shift. His blood gasses have obviously improved, but other things are going wrong now. His Cr was hovering around 3 this morning. It will be interesting to see if he has progressed at all when I return to work on Tuesday night.

I will keep you updated... oh, and if anyone thinks that I have too much patient information on here, and that I should edit the post, please let me know. I'm just trying to get the word out about what's going on in my unit.

Our perfusionists have been following what's going on in countries like New Zealand, and they state they have been prepping for an onslaught of ARDS patients.

Kudos to Indigo Girl for keeping this thread going!

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

16 Articles; 71,071 Visitors; 7,339 Posts

Thanks cOntagion for your post. I don't think there's too much info in there. The odds of any of us IDing your patient are pretty slim.

The getting-worse-before-getting-better thing seems to be common with severe H1N1. We've seen the phenomenon with other severe respiratory illnesses needing ECLS on our unit over the years. I heard the other day that we have 2 patients right now with H1N1 that went unrecognized for more than a day because of mild illness in patients admitted for something else... They were in the main unit and may have exposed EVERYONE. I'm guessing the fertilizer has hit the oscillatory air circulating device. I'll find out when I go in tonight.

Meanwhile, our vaccination blitz has only started today; I still haven't gotten my seasonal flu shot due to logistical issues. I heard on Friday that our government has decided not to send public health into my son's day program - a program filled with about 65 adults with a variety of developmental issues and physical and mental handicaps who are at high risk for severe disease - AND who cannot practice respiratory hygiene. They did have a seasonal flu shot day on the 9th where public health came in and shot everybody. Many of them live in group homes and are wards of the public guardian; they're not likely to be aware of the need for, nor able to attend local clinics for their shots. So not only are they throwing them to the wolves but they're putting all of their contacts at risk. Makes me ill. I'm going to be complaining...

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indigo girl works as a visiting nurse.

28,143 Visitors; 5,172 Posts

H1N1: Flu 'Pushing Hospitals to Their Limits'

http://www.delmarvanow.com/article/20091027/NEWS01/91027019/1002/H1N1--Flu--pushing-hospitals-to-their-limit-

Some patients' lungs are in such bad shape that doctors bypass them using an advanced ventilation technique called ECMO, for extra-corporeal membrane oxygenation, which works something like the heart-lung machines that are used during heart surgery.

The University of Michigan, which pioneered the technique, has started a national registry of H1N1 patients. As of Oct. 9, the latest data available, at least 54 flu patients have been so sick that they've needed a temporary lung bypass; 62.8% of those whose outcomes are known survived, says Pauline Park, co-director of the hospital's critical care unit.

Brower, of Hopkins, says doctors are still divided on whether the technique provides an extra benefit to patients with adult respiratory distress syndrome. But, he says, it represents one illustration of how far medicine has come since the 1918 epidemic, which occurred long before researchers discovered that flu was caused by a virus.

(hat tip flutrackers/shiloh)

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NYVADRN has 17 years experience.

573 Visitors; 1 Post

hello all- just discovered this thread and it has been fascinating. was wondering if anyone out there as encountered the use of the Tandem Heart (percutaneous or surgical extra corporeal circulatory assist) - used with an oxygenator spliced in...Perfusion does not necessarily HAVE to stay at bedside and the device is way smaller than traditional ECMO.

Device can be viewed at TandemHeart.com :heartbeat

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

16 Articles; 71,071 Visitors; 7,339 Posts

It looks sort of similar to the Berlin heart that we use on our peds patients. We've had a few that we've cut in oxygenators for. We still have an ECLS specialist caring for the patient though because the oxygenator adds a level of complexity and risk that needs a certain degree of expertise, and more complex anticoagulation that a simple VAD. Somehow I don't think this type of support will be the most appropriate for pulmonary failure, though.

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