Abstract
This article presents the successful treatment with Extracorporeal Membrane Oxygenation (ECMO) of an 11-year-old girl with life-threatening acute respiratory failure associated with the novel influenza A (H1N1) outbreak of 2009. Admitted with wheezing and fever of 37.8°C, her respiratory condition rapidly deteriorated and was transferred to our unit. Her SpO2 remained between 80-85% with 10 L/minute flow of oxygen, and aggressive mechanical ventilation did not improve her condition. X-rays revealed atelectasis on the right upper-middle area and left lower areas of the lung accompanied with pneumomediastinum. As respiratory acidosis was progressing, we commenced ECMO. She exhibited a rapid improvement in response to veno-venous ECMO, and her cardiopulmonary condition stabilized. Oseltamivir (450mg/day) was administered through a naso-duodenal tube. Aggressive pulmonary treatment with administration of a surfactant and bronchial toileting was performed. No ECMO complications were observed, and the child's pulmonary condition improved rapidly. After 73 hours, the child was successfully weaned from ECMO, and was extubated the following day with no recurrent dyspnea. In this case, ECMO was life-saving, and we recommend that ECMO be introduced immediately upon failure of mechanical ventilator management in children with severe respiratory failure associated with novel influenza A (H1N1).
