ECMO Support for Influenza A: Retrospective Review of the ELSO Registry Comparing Seasonal and Pandemic Subtypes

Abstract Background: While there is substantial published experience of ECMO during the H1N1 pandemic, less is known about the use of ECMO in patients with seasonal influenza A virus. We hypothesized that the severity of illness and survival of patients supported with extracorporeal membrane oxygenation (ECMO) would differ for those with seasonal influenza A vs pandemic H1N1 (H1N1) influenza A.Methods: Retrospective study of ECMO supported adults (>18 years) with influenza A viral infection reported to the Extracorporeal Life Support Organization (ELSO) Registry between 2009-2019. We describe the incidence and compare characteristics and factors associated with in-hospital survival using a least absolute shrinkage and selection operator regression.Results: Of 2461 patients supported with ECMO for influenza A, 445 had H1N1 and 2004 had seasonal influenza A. H1N1 was the predominant subtype between 2009-2011. Pandemic H1N1 patients were younger, with more severe illness at ECMO cannulation and higher reported ECMO complications than those with seasonal influenza A. Patient characteristics including younger age and higher weight, and patient management including longer ventilation duration before ECMO were associated with worse survival. ECMO complications were associated with reduced survival. There was no difference in survival to hospital discharge according to influenza subtype after adjusting for other characteristics.Conclusions: Patients supported with ECMO for pandemic H1N1 were younger, with more severe illness than those supported for seasonal influenza A. Survival to hospital discharge, was associated with patient characteristics, management, and ECMO complications, but was not impacted by the specific influenza A subtype.Trial registration: N/A