The First Case of Severe Novel H1N1 Influenza Successfully Rescued by Extracorporeal Membrane Oxygenation in Taiwan

During the novel influenza A (H1N1) pandemic, some patients developed acute respiratory distress syndrome or severe cardiopulmonary failure despite the use of conventional management. Extracorporeal membrane oxygenation (ECMO) support may successfully rescue these severely ill patients. Here, we report the first case of severe novel H1N1 infection with multiorgan failure that was successfully treated with antiviral therapy and ECMO in Taiwan. A 32-year-old man had acute onset of fever, dry cough, rhinorrhea, and sore throat 2 days after returning from Dongguan, China. He attended Hospital A and chest radiography revealed bilateral lung consolidation. Rapid influenza antigen testing was negative. He was intubated 2 days later due to hypoxic respiratory failure and persistent shock refractory to conventional management. Because of compromised cardiopulmonary function, venoarterial ECMO support was started 4 days after the onset of symptoms and he was transferred to Hospital B on July 25, 2009. As history taking found clustering of influenza-like illness, oseltamivir was given immediately under the impression of severe influenza illness. Real-time reverse transcriptase-polymerase chain reaction of respiratory sample for novel H1N1 virus revealed positive results. In addition, blood cultures collected at Hospital A yielded Streptococcus pneumoniae, and β-hemolytic Streptococcus other than group A, B or D. Hospital course was uneventful and he was discharged 26 days after transfer to Hospital B. This experience showed that ECMO can be life-saving for severe novel H1N1 infection. [J Formos Med Assoc 2009;108(11):894–898]