Publication:

Successful management of severe acute respiratory distress syndrome caused by H1N1 viral pneumonia using early institution of extra corporeal membrane oxygenation therapy

Swine flu is H1N1 influenza A virus infection that has serious consequences in susceptible individuals leading to acute respiratory distress syndrome (ARDS). Sometimes ARDS can be refractory to conventional management and ventilator strategies. In such patients Extracorporeal Membrane Oxygenation (ECMO) improves respiratory functions wherein the gas exchange is done via a membrane oxygenator and a pump. We report a case of 50 years old female presented in February 2016 with complaints of fever, headache, dry cough, rhinorrhea and difficulty in breathing for four days. Her throat swab showed positive report for H1N1 infection. She developed severe ARDS due to pneumonia caused by H1N1 influenza infection. Her paO2/FiO2 was less than 100. The patient did not respond to initial management with anti- influenza therapy and mechanical ventilation. Murray score was calculated to institute ECMO therapy. Murray score of our patient was 2.75. Since there was no co- morbid illness or irreversible lung disease, ECMO therapy was started. After 14 days of ECMO therapy, ARDS resolved and the patient was successfully weaned from the ventilator. Patient was monitored intensively for coagulopathies and other complications related to ECMO therapy. She developed hemothorax and critical illness neuropathy during ECMO therapy. ECMO is a salvage therapy that has the potential to save lives when conventional treatment fails in H1N1 associated ARDS. It not only ensures much needed lung protection to the inflamed lung but also provides better hemodynamic stability. Early institution of ECMO along with ultra-protective ventilation of lung and timed weaning is the key to successful management of severe ARDS due to swine flu. There are very few case reports of successful ECMO therapy in H1N1 associated ARDS available from Delhi.