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. 2011 Sep;37(9):1447-57.
doi: 10.1007/s00134-011-2301-6. Epub 2011 Jul 6.

The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks

Nicolò Patroniti  1 , Alberto Zangrillo, Federico Pappalardo, Adriano Peris, Giovanni Cianchi, Antonio Braschi, Giorgio A Iotti, Antonio Arcadipane, Giovanna Panarello, V Marco Ranieri, Pierpaolo Terragni, Massimo Antonelli, Luciano Gattinoni, Fabrizio Oleari, Antonio Pesenti
Affiliations

The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks

Nicolò Patroniti et al. Intensive Care Med. 2011 Sep.

Abstract

Purpose: In view of the expected 2009 influenza A(H1N1) pandemic, the Italian Health Authorities set up a national referral network of selected intensive care units (ICU) able to provide advanced respiratory care up to extracorporeal membrane oxygenation (ECMO) for patients with acute respiratory distress syndrome (ARDS). We describe the organization and results of the network, known as ECMOnet.

Methods: The network consisted of 14 ICUs with ECMO capability and a national call center. The network was set up to centralize all severe patients to the ECMOnet centers assuring safe transfer. An ad hoc committee defined criteria for both patient transfer and ECMO institutions.

Results: Between August 2009 and March 2010, 153 critically ill patients (53% referred from other hospitals) were admitted to the ECMOnet ICU with suspected H1N1. Sixty patients (48 of the referred patients, 49 with confirmed H1N1 diagnosis) received ECMO according to ECMOnet criteria. All referred patients were successfully transferred to the ECMOnet centers; 28 were transferred while on ECMO. Survival to hospital discharge in patients receiving ECMO was 68%. Survival of patients receiving ECMO within 7 days from the onset of mechanical ventilation was 77%. The length of mechanical ventilation prior to ECMO was an independent predictor of mortality.

Conclusions: A network organization based on preemptive patient centralization allowed a high survival rate and provided effective and safe referral of patients with severe H1N1-suspected ARDS.

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Figures

Fig. 1
Fig. 1
Management algorithm for the referrals to the Italian ECMOnet system
Fig. 2
Fig. 2
Flow diagram of patients with suspected influenza A(H1N1) admitted to the ICU of the ECMOnet centers. ECMO Extracorporeal membrane oxygenation
Fig. 3
Fig. 3
Survival in relation to the days of mechanical ventilation (MV) before ECMO. Results are shown for quartiles according to days of MV before ECMO. Fisher’s exact test P < 0.01
See this image and copyright information in PMC

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