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Review
. 2010 Dec;42(4):268-80.

Extracorporeal life support for pandemic influenza: the role of extracorporeal membrane oxygenation in pandemic management

Ed DeLaney  1 , Michael J Smith, Brian T Harvey, Keith J Pelletier, Michael P Aquino, Justin M Stone, Gerald C Jean-Baptiste, Julie H Johnson
Affiliations
Review

Extracorporeal life support for pandemic influenza: the role of extracorporeal membrane oxygenation in pandemic management

Ed DeLaney et al. J Extra Corpor Technol. 2010 Dec.

Erratum in

  • J Extra Corpor Technol. 2011 Mar;43(1):41

Abstract

The recent global threat of a severe pandemic influenza outbreak has suggested that extracorporeal life support will begin to play an evolving role in the care of critically ill influenza stricken patients. The highly communicable attributes of influenza could result in widespread infection and an associated increased need for advanced life support. Supply and demand equilibrium may be abruptly disrupted, and ethical decisions regarding the allocation of life saving resources will inevitably need to be made. Protocol oriented planning, research analysis, and advanced technologies are critical factors in averting catastrophe. This review article details the epidemiology, diagnostic techniques, and interventions for the influenza A virus, including H1N1.

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Conflict of interest statement

The senior author has stated that authors have reported no material, financial, or other relationship with any healthcare-related business or other entity whose products or services are discussed in this paper.

Figures

Figure 1.
Figure 1.
Maquet Quadrox D (top) and Quadrox iD (bottom) PMP oxygenators (Maquet, Rastatt, Germany). Quadrox D has a 250 mL prime volume with a flow range of .5–7 L/min. Quadrox iD has a prime volume of 81 mL and a flow range of .2–2.8 L/min.
Figure 2.
Figure 2.
Simple veno-venous ECMO circuit with cannulation of the right atrium and femoral vein.
Figure 3.
Figure 3.
Simplified veno-venous ECMO circuit with a Quadrox D PMP oxygenator. Figure courtesy of Robert Brown.
Figure 4.
Figure 4.
Avalon Elite® bi-caval dual lumen catheter placement. Catheter is inserted percutaneously via the internal jugular vein into the vena cavae and right atrium. Notice the cannula fenestrations in the superior and inferior vena cava where deoxygenated blood is removed from the patient. Oxygenated blood is then returned to the right atrium via the alternate lumen of the catheter.
Figure 5.
Figure 5.
Typical veno-arterial ECMO circuit with safety devices and monitoring ports. Figure courtesy of Robert Brown.
Figure 6.
Figure 6.
TandemHeart® ECMO circuit. The centrifugal pump is driven by a three phase, brushless, DC servomotor, has a 10 cc prime volume, and is capable of delivering flows up to 5 L/min.
Figure 7.
Figure 7.
CentriMag® ECMO circuit. This extracorporeal blood pump is bearingless, works by magnetic levitation, and has been approved as a right ventricular assist device for up to 30 days. It has a 31 mL prime volume and is capable of delivering flows up to 10 L/min.
See this image and copyright information in PMC

References

    1. World Health Organization (WHO). Pandemic (H1N1) 2009-update 86. Available at: http://www.who.int/csr/don/2010_02_5/en/ (Accessed February 11, 2010).
    1. Center for Disease Control and Prevention. CDC estimates of 2009 H1N1 influenza cases, hospitalizations and deaths in the United States, April-October 17, 2009. Available at: http://www.cdc.gov/h1n1flu/estimates/April_October_17.htm (Accessed November 12, 2009).
    1. World Health Organization (WHO). World now at the start of 2009 influenza pandemic. Available at: http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6... (Accessed October 8, 2009).
    1. Royal College of Physicians. Preparations for pandemic influenza: Guidance for hospital medical specialties on adaptations needed for a pandemic influenza outbreak. Available at: http://bookshop.rcplondon.ac.uk/contents/f2df511c-f131-4fa1-8b7b-66105a0... (Accessed March 14, 2010).
    1. Department of Health (DH). Swine flu, guidance for planners (October 22, 2009). Available at: http://www.dh.gov.uk/en/Publications andstatistics/Publications/Publicat... (Accessed March 14, 2010).

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