Open Access Highly Accessed Research article

Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center

Giovanni Cianchi1, Manuela Bonizzoli1, Andrea Pasquini1, Massimo Bonacchi2, Giovanni Zagli1*, Marco Ciapetti1, Guido Sani2, Stefano Batacchi1, Simona Biondi3, Pasquale Bernardo2, Chiara Lazzeri2, Valtere Giovannini4, Alberta Azzi5, Rosanna Abbate6, Gianfranco Gensini6 and Adriano Peris1

Author Affiliations

1 Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, 50139, Florence, Italy

2 Heart and Vessels Department, Careggi Teaching Hospital, Largo Brambilla 3, 50139, Florence, Italy

3 Post graduated school of Anesthesia and Intensive Care, University of Florence, Largo Brambilla 3, 50139, Florence, Italy

4 Regional Health System, Viale Pieraccini 28, 50134, Florence, Italy

5 Department of Public Health, University of Firenze, Viale Morgagni 48, 50139, Florence, Italy

6 Department of Critical Care Medicine and Surgery, Careggi Teaching Hospital, Largo Brambilla 3, 50139, Florence, Italy

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BMC Pulmonary Medicine 2011, 11:2  doi:10.1186/1471-2466-11-2

Published: 11 January 2011



Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance.


Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination.


A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%.


In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.