Summary
We report four patients with novel observations during extracorporeal membrane oxygenation support (ECMO). ECMO was initiated because of severe ARDS due to the primary H1N1 pandemic influenza pneumonia. Two patients had excessive conjugated hyperbilirubinemia and two had unproportional depletion of the coagulation factor IX. Pathogenetic mechanisms and clinical relevance of the noticed phenomena are discussed.
Keywords: Extracorporeal membrane oxygenation, Hyperbilirubinemia, Factor IX, Pandemic H1N1 influenza, Cholestasis
Zusammenfassung
Wir berichten über neue Phänomene, die wir bei vier Patienten während des Einsatzes einer ECMO beobachtet haben. Die ECMO wurde wegen schwerem ARDS als Folge einer Pneumonie im Rahmen einer pandemischen Infektion mit H1N1 Influenza durchgeführt. Zwei Patienten hatten einen exzessiven Anstieg von konjugiertem Bilirubin im Serum. Die anderen zwei Patienten hatten einen unverhältnismäßigen Abfall des Gerinnungs Faktors IX. Die pathogenetischen Mechanismen und die klinische Bedeutung dieser beobachteten Phänomene werden diskutiert.
References
- Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators. Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA. 2009;302:1888–1895. doi: 10.1001/jama.2009.1535. [DOI] [PubMed] [Google Scholar]
- Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, CESAR trial collaboration et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–1363. doi: 10.1016/S0140-6736(09)61069-2. [DOI] [PubMed] [Google Scholar]
- Abbasi S, Stewart DL, Radmacher P, Adamkin D. Natural course of cholestasis in neonates on extracorporeal membrane oxygenation (ECMO): 10-year experience at a single institution. ASAIO J. 2008;54:436–438. doi: 10.1097/MAT.0b013e31817f588a. [DOI] [PubMed] [Google Scholar]
- Hermans C, Altisent C, Batorova A, Chambost H, De Moerloose P, Karafoulidou A, et al. European Haemophilia Therapy Standardisation Board. Replacement therapy for invasive procedures in patients with haemophilia: literature review, European survey and recommendations. Haemophilia. 2009;15:639–635. doi: 10.1111/j.1365-2516.2008.01950.x. [DOI] [PubMed] [Google Scholar]