Emergent ECLS for life-threatening severe cardiac dysfunction as presentation of H1N1-flu

The novel influenza A (H1N1) pandemic caused an epidemic of critical illness and some patients developed severe acute respiratory distress syndrome (ARDS) or severe cardiopulmonary failure despite the use of conventional management. Extracorporeal Membrane Oxygenation (ECMO) support may successfully rescue these severely ill patients. We report the successful use of extra-corporeal cardiopulmonary support (ECLS) in ECMO modality, in an atypical presentation of H1N1 flu in a young male patient as severe cardiac dysfunction. Methods:We demonstrate the causative role of H1N1 in refractory ARDS of a previously healthly 15-year-old man who presented to the intensive care unit with an hypoxic and persistent cardiogenic shock refractory to conventional management as the leading symptom of influenza A . The patient required ventilator support. Because of compromised cardiopulmonary function, veno-venous ECMO was applied 24h after admission. Despite the patient was manifesting heart failure we decided the placement of veno-venous ECMO because we believed that the real problem were the uncontrollable hypoxia and hypercapnia. Results:ECMO allowed specific therapy starting while maintaining end-organ oxygenation and supported the patient until completely lung recovery. A normal left ventricular ejection fraction was documented on a 2D echocardiography on day 2. The patient after 6 days of ECMO recovered completely and was successfully weaned from the mechanical ventilator on the 9th day after admission. The patients was discharged from the hospital on the 15th day. Conclusion:This experience showed that ECMO can be life-saving for severe H1N1 infection also in patients with atypical clinical presentation of influenza.