SUCCESSFUL TREATMENT OF ADULTS WITH SEVERE HANTAVIRUS PULMONARY SYNDROME WITH EXTRACORPOREAL MEMBRANE-OXYGENATION

Objective: To describe our experience with the use of extracorporeal m embrane oxygenation (ECMO) as a rescue therapy in adult patients with severe cardiopulmonary failure from Hantavirus pulmonary syndrome. Des ign: Case series. Setting: Tertiary referral center. Patients: Patient s with confirmed Hantavirus infection, who developed severe cardiopulm onary failure in which conventional therapy was assessed as being unsu ccessful. Interventions: Records of previous patients treated for Hant avirus pulmonary syndrome were reviewed and findings consistent with 1 00% mortality were found. Measurements and Main Results: Findings asso ciated with a 100% mortality rate were a) cardiac index of <2.5 L/min/ m(2); b) serum lactate concentration of >4.0 mmol/L (normal range 0.0 to 2.2); c) pulseless electrical activity or ventricular fibrillation or ventricular tachycardia; and d) refractory shock despite fluid resu scitation, and vasoactive medications. From 1994 to 1996, seven patien ts were admitted with confirmed Hantavirus pulmonary syndrome and seve re cardiopulmonary failure. Three of the seven patients had at least t wo of the four criteria for a 100% morality rate listed above, and app eared to be failing optimal conventional therapy. These three patients received support with venoarterial ECMO. The first patient was placed on ECMO during cardiac arrest and died. The next two patients who rec eived ECMO for Hantavirus pulmonary syndrome survived after relatively short, uncomplicated ECMO runs, and were discharged without complicat ions. Conclusions: ECMO successfully provided cardiopulmonary support in two patients with severe Hantavirus pulmonary syndrome who survived with a good outcome. Our experience suggests that ECMO is a beneficia l therapy for patients critically ill with Hantavirus [ulmonary syndro me.