JAMA: ECMO Centers and Mortality From Influenza A(H1N1)

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JAMA. 2012;307(5):454. doi: 10.1001/jama.2012.57

Letters
JAMA. 2012;307(5):454. doi: 10.1001/jama.2012.57
ECMO Centers and Mortality From Influenza A(H1N1)

Joost D. Haeck, MD, PhD;
Dave A. Dongelmans, MD, PhD;
Marcus J. Schultz, MD, PhD



To the Editor: Dr Noah and colleagues found that the mortality rate was lower among patients with severe suspected or confirmed 2009 influenza A(H1N1) and acute respiratory distress syndrome (ARDS) who were transferred to 4 specialized centers in the United Kingdom for treatment with extracorporeal membrane oxygenation (ECMO) compared with matched critically ill patients who were not transferred.1

The ventilatory parameters in the ECMO-referred patients at transfer are shown in eTable 2 of the article. The median tidal volume was 5.2 mL/kg (interquartile range, 4.0-6.5 mL/kg) of actual body weight. However, information on the respiratory values during treatment in non?ECMO-referred patients with H1N1 and ARDS was not described. Because lower tidal volumes are associated with a lower mortality rate in ARDS patients due to reduced ventilator-associated lung injury,2 it would be valuable to also provide information on the respiratory values during treatment in non?ECMO-referred patients with H1N1 and ?

http://jama.ama-assn.org/content/307/5/454.3.extract

[tetano]

Re: JAMA: ECMO Centers and Mortality From Influenza A(H1N1)

JAMA. 2012;307(5):454-455. doi: 10.1001/jama.2012.58

Letters
JAMA. 2012;307(5):454-455. doi: 10.1001/jama.2012.58
ECMO Centers and Mortality From Influenza A(H1N1)?Reply

Giles J. Peek, FRCS (CTh), MD;
Kathryn M. Rowan, PhD



In Reply: The SwiFT (Swine Flu Triage) Study collected only a minimal set of daily critical care data for the 1756 H1N1 cases in 193 hospitals (predominantly those sufficient to calculate a Sequential Organ Failure Assessment score), given the pandemic context. More detailed additional data, however, were collected on a much smaller number of cases (n = 80) referred to 1 of the 4 ECMO centers. Therefore, as Dr Haeck and colleagues point out, information on respiratory values during treatment in non?ECMO-referred patients with H1N1 was not available.

In the absence of these definitive respiratory values during treatment for non?ECMO-referred patients, but with a view to exploring the hypothesis that Haeck et al outline, we conducted 2 sensitivity analyses limiting comparison of the ECMO-referred patients to non?ECMO-referred patients treated in critical care units either with a higher volume of ventilated patients or with a lower standardized mortality ratio?characteristics associated with better outcomes ?

http://jama.ama-assn.org/content/307/5/454.4.extract