MedWire News: Many critically ill patients in Australia and New Zealand who were infected with the influenza H1N1 (swine flu) virus during the winter months of 2009 in the southern hemisphere needed prolonged life support treatment, study results show.
Andrew Davies (Alfred Hospital, Melbourne, Australia) and team therefore warn medical professionals not to underestimate the impact of swine flu during the coming winter flu season in the northern hemisphere.
For their study, the researchers assessed data from all 187 intensive care units (ICUs) in Australia and New Zealand for the 2009 winter period between June 1 and August 31.
They found that 68 patients with swine flu-associated acute respiratory distress syndrome (ARDS) were treated with extracorporeal membrane oxygenation (ECMO) at 15 ICUs during the study period. A further 133 patients with swine flu-associated ARDS received mechanical ventilation but no ECMO in the same ICUs.
The 68 patients who received ECMO were aged 26.6–43.1 years (mean age 34.4 years) and 50% were men. Before receiving ECMO, these patients had severe respiratory failure despite advanced mechanical ventilatory support.
The most common associated comorbidities among these patients were obesity (50%), asthma (28%), and diabetes mellitus (15%). Six patients were pregnant and four were postpartum (less than 28 days since delivery).
The average duration of ECMO treatment was 10 days, with a range of 7–15 days, and the patients stayed in hospital for an average of 39 days.
At the time of the report (7 September 2009), 54 of the 68 patients were alive and 14 had died. Six patients remained in the ICU, including two who were still receiving ECMO. Sixteen patients were still in hospital but had moved out of the ICU and 32 had been discharged from the hospital.
The researchers conclude in the Journal of the American Medical Association: “During June to August 2009 in Australia and New Zealand, the ICUs at regional referral centers provided mechanical ventilation for many patients with 2009 influenza A (H1N1)–associated respiratory failure, one-third of whom received ECMO.
“Despite their illness severity and the prolonged use of life support, most of these patients survived.”
Co-researcher David Gattas (Royal Prince Alfred Hospital, Sydney, Australia) added: “The findings of the study should be widely read in the northern hemisphere and we hope this knowledge will help medical teams who may have to make fast decisions about starting advanced life supports such as ECMO. Many of these severely affected flu victims can survive.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
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