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Referral for ECMO during H1N1 in the UK

Referral for ECMO during H1N1 in the UK. Mr Chris Harvey Locum Consultant in Adult and Paediatric ECMO Glenfield Hospital, Leicester UK. Started as a Fairytale. 22 nd July 2009.

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Referral for ECMO during H1N1 in the UK

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  1. Referral for ECMO during H1N1 in the UK Mr Chris Harvey Locum Consultant in Adult and Paediatric ECMO Glenfield Hospital, Leicester UK

  2. Started as a Fairytale

  3. 22nd July 2009

  4. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome.Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators, Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, Forrest P, Gattas D, Granger E, Herkes R, Jackson A, McGuinness S, Nair P, Pellegrino V, Pettilä V, Plunkett B, Pye R, Torzillo P, Webb S, Wilson M, Ziegenfuss M.JAMA. 2009 Nov 4;302(17):1888-95. Epub 2009 Oct 12.

  5. Referral to an Extracorporeal Membrane Oxygenation Centerand Mortality Among PatientsWith Severe 2009 Influenza A(H1N1) Noah et al JAMA. 2011;306(15):doi:10.1001/jama.2011.1471

  6. Referrals - Glenfield Hospital Call Centre

  7. ECMO Patients • 80 patients transferred for consideration of ECMO • 69 patients received ECMO • 4 Hospitals • 51 Glenfield Hospital • 18 Royal Brompton Hospital • 7 Papworth Hospital • 4 Aberdeen Royal Infirmary

  8. Data collected from SwiFT Study • Web based study with data collected from 192 acute hospitals throughout the UK • Patients 14th July 2009 to 19th February 2010 • ECMO Patients matched by • Individual Matching • Propensity Matching • GenMatch Matching

  9. Number of days ventilated • FiO2 • PaO2/FiO2 ratio • SOFA score • Age • Pregnancy • BMI • H1N1 Status • Use of iNO, HFOV, Prone positioning • Cardiac support • Renal support

  10. 12 by Fixed Wing 50 by Road 6 by Helicopter 6 with mobile ECMO

  11. ECMO Deaths • 10 died on ECMO • 7 cerebral haemorrhage • 1 cardiac arrest • 1 progressive multi-organ failure • 1 massive pulmonary haemorrhage • 6 died off ECMO • 4 died after discharge to referring hospital • 2 died after conventional treatment

  12. 2010-2011

  13. Swine Flu 2010-2011 • 87 patients treated with ECMO survival 74% • Glenfield Hospital • Brompton Hospital • Guy’s and St Thomas’s • Papworth Hospital • Freeman Hospital • Wythenshawe Hospital • Aberdeen Royal Infirmary • Blackpool Hospital • Golden Jubilee Hospital

  14. During swine flu 332 referrals

  15. Any questions?

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