Transferring patients with refractory hypoxemia to a regional extracorporeal membrane oxygenation center: key considerations for clinicians.

Because of technological advancements and encouraging experiences during the 2009 influenza A (H1N1) epidemic, many critical care clinicians consider extracorporeal membrane oxygenation (ECMO) a reasonable strategy for managing patients with refractory hypoxemia when standardized therapies have failed. Although the literature remains unclear as to whether it should be considered a routine or a rescue strategy in the management of patients with severe acute respiratory distress syndrome, experts agree that ECMO therapy is most likely to result in positive outcomes and fewer complications when provided at regional ECMO centers. Some institutions have developed the expertise and resources required to provide this sophisticated therapy, but significantly more facilities may choose to send their patients to a tertiary ECMO center when they do not respond to usual care.

Critically ill patients with H1N1 influenza A undergoing extracorporeal membrane oxygenation.

The most common cause of death due to the H1N1 subtype of influenza A virus (swine flu) in the 2009 to 2010 epidemic was severe acute respiratory failure that persisted despite advanced mechanical ventilation strategies. Extracorporeal membrane oxygenation (ECMO) was used as a salvage therapy for patients refractory to traditional treatment. At Legacy Emanuel Hospital, Portland, Oregon, the epidemic resulted in a critical care staffing crisis.