Tuesday, November 24, 2009

Article On Boy In Omaha With Lung Failure on Respirator - they say H1N1 related - 11/24/09 1:20

Article On Boy In Omaha With Lung Failure on Respirator - they say H1N1 related

I am putting this in here, because I believe we all need to be aware and watch for these "lung" related "Swine Flu" sicknesses. Also, considering Omaha is next to Iowa, I found this article of high interest. The article has information on a few children who have had lung failures. It also mentioned how a new drug has been used 703 times (was that for lung related problems?)


Susie Damm could do nothing but entrust her son's life to doctors and a sci-fi-sounding gizmo called ECMO.

“It sounded pretty scary,” Damm said, “but I made the decision to do it.”

Damm's son, 19-year-old Ryan Damm, was in a battle for his life with lung failure related to H1N1 flu. His mother's decision to let Children's Hospital & Medical Center staff put him on ECMO proved a good one. Ryan Damm is rebounding.

“It was basically my last option for him to survive,” Susie Damm said Friday.

Medical personnel in Nebraska, Iowa and elsewhere are using at least two somewhat radical therapies to try to beat life-threatening cases of H1N1 flu.

One is ECMO, which stands for “extracorporeal membrane oxygenation.” Very simply, it's a machine that serves as lungs, mechanically supplying oxygen to the patient's blood and removing carbon dioxide.

The other is an intravenous flu medicine called peramivir (per-AM-uh-veer), which last month received emergency approval for use from the federal government. It hasn't cleared the standard approval process that drugs typically undergo in the United States.

A physician may request permission to use peramivir from the federal Centers for Disease Control and Prevention. By the middle of last week, the drug had been used in 703 cases, a CDC spokesman said.

A patient who received peramivir, 22-year-old Chris Dekker of Norfolk, Neb., has been released from the Creighton University Medical Center and is regaining strength and lung capacity at Madonna Rehabilitation Hospital in Lincoln.

Dekker's father, Doug, said Creighton personnel worked hard to save his son, who was on a ventilator about 18 days.

“I don't know that we can say definitively that any one thing is what saved Chris,” his father said.

Peramivir is appropriate when standard flu medicines aren't working or when taking medications by mouth or nose is complicated by a ventilator or the patient's weakened condition, federal health officials have said.

Dr. Mark Rupp, infectious disease specialist at the Nebraska Medical Center, said peramivir has been studied by using small groups of ill people, but it hasn't been through the standard course of trials.

Nevertheless, Rupp said, the federal government determined that the benefit of using the drug outweighed the risk. “I think that it's appropriate,” Rupp said. It “puts one more weapon at our disposal to fight the virus.”

Rupp said that to his knowledge, the drug hasn't been used yet at the the Nebraska Medical Center.

ECMO has been used twice at the med center, and both patients have survived.

At Children's Hospital in Omaha, Dr. Jeff DeMare and his team have used ECMO on two H1N1 patients, including Ryan Damm, who were suffering respiratory failure.

ECMO is a set of devices, monitors and tubes that remove blood from a patient and restore it with oxygen. ECMO, which has been around in some form for decades as a respiratory failure device, has been used elsewhere in rare instances for patients suffering with seasonal flu, too.

The device costs at least $100,000, DeMare said, and Children's has two, plus one backup. One day of ECMO use costs a patient $5,000 to $6,000, and insurance helps pay those costs, a spokeswoman at Children's said. The two H1N1 patients who received ECMO treatment were on it for close to 10 days each.

DeMare said a 7-year-old girl was treated in the second H1N1 case involving ECMO.

“We've had great results here,” DeMare said. Both patients should be fine over the long haul, he said.

Dr. William Lynch, a thoracic surgeon at the University of Iowa Hospitals and Clinics, said ECMO is being used worldwide far more than before because of H1N1 flu. He said four H1N1 patients have been put on ECMO at his hospital, and three have survived.

Lynch cautioned that ECMO involves a complicated interaction with the patient.

“You have to understand the nuances of how the two entities affect each other,” he said. “There is risk with everything.”

That is certainly true of ECMO, which requires hooking tubes to large veins. Excessive bleeding or blood clotting can occur, Lynch said.

Nevertheless, experts think ECMO gives weak and damaged lungs a chance to rest and heal.

Dr. Anne O'Keefe, senior epidemiologist for the Douglas County Health Department, said ECMO is saving lives.

“I guess it kind of shows you the miracles of modern medicine,” O'Keefe said. “It's pretty exciting.”

UPDATE 11/24/ 3:25PM Another article about ECMO's

Trying last-ditch lung bypass for worst swine flu

WASHINGTON -A technology originally developed for premature babies may be helping to save some of the sickest swine flu patients by rerouting their blood so their lungs can rest.
It's a risky approach using equipment that only certain specialized hospitals have. But faced with children and young adults struggling to breathe despite ventilators has intensive-care doctors dusting off these machines, named ECMO, that they often consider last-ditch and almost never use for influenza.
"It was pretty scary knowing that was his blood flowing through those tubes in and out of his body," says Susie Damm of Omaha, Neb., whose 19-year-old son Ryan survived a life-threatening bout after 10 days on ECMO.
"I was one of the people sick and tired of hearing about the swine flu, thinking people were making a big deal of it," she adds. "Now I've had a different look, and I'm very, very thankful" he survived.
No one knows which patients are most likely to benefit — not everyone does. But ECMO is gaining attention after Australian researchers reported that the machines helped during that country's outbreak of what scientists call the 2009 H1N1 flu strain. A voluntary U.S.-based registry counts 107 critically ill swine flu patients recently treated with ECMO, most from this country.
In Omaha, Dr. Jeff DeMare credits the technique with saving Ryan Damm and 7-year-old Tania Romero-Oropeza after both patients' lungs went from clogged to nearly useless in a stunning matter of hours. Tania's care was complicated by a drug-resistant staph infection.
"You wonder, 'OK, we've got a lot of folks who get this disease and why is it so bad in some cases?' We don't have a real good handle on that," says DeMare, a critical care specialist at Children's Hospital & Medical Center.
Whatever the reason, "your body needs time to fight the infection," he adds, and he gambled that the pricey equipment could buy that time.
Estimates from the federal Centers for Disease Control and Prevention suggest that swine flu has hospitalized 98,000 Americans in the past six months, and killed nearly 4,000. For most, standard treatment works.
But the sickest often need ventilators to pump their lungs, and ventilators damage lung tissue, especially as they're turned up to higher pressures as patients worsen.
Hospitals are "exhausting all measures" on those patients, says Dr. Pauline Park, a University of Michigan ICU co-director who's helping to analyze the ECMO registry in hopes of determining best candidates. "Physicians don't want to give false hope to families, but also don't want to stand by if a life can be saved."
Enter ECMO, decades-old technology that essentially offers a temporary lung bypass. Tubes carry blood out of the body so a filter can remove carbon dioxide and reinfuse oxygen, and then dump the blood back.
It's a twist on the heart-lung machine used for open-heart surgery, modified so that patients can stay on the machine for weeks instead of just hours and, key here, so that blood doesn't have to bypass the heart if only the lungs need a rest.
There are many cautions. It's risky, requiring blood thinners to avoid clots and posing the potential for additional infection. It can double the cost of ICU care. Only about 120 hospitals in the U.S. offer it, most just a few times a year for newborns with respiratory failure, its primary use.
ECMO in adults is hugely controversial because past research couldn't prove that it significantly increased survival.
Here's what's new:
_Australian researchers reported last month that they used ECMO in 68 critically ill swine flu patients who failed standard care, and about 71 percent survived. That research predicted some 800 people might be ECMO candidates if the U.S. experienced similar rates of swine flu.
_Coincidentally, a British study also published last month found that nearly two-thirds of adults randomly assigned to ECMO survived other types of respiratory failure — before swine flu hit — while just 47 percent survived with regular ICU care. It's the most rigorous study of ECMO performed in adults and one that has lung specialists debating wider use.
_Preliminary data from the Michigan-run ECMO registry suggests survival can reach 72 percent if recipients get it within six days of using a ventilator. With longer ventilator use, the survival rate plummets.
Back in Omaha, DeMare agrees ECMO shouldn't be last-ditch, noting his own patients were on ventilators for just hours before getting it. Still, Tania had a monthlong hospital stay, including her eight days on ECMO.
"Thank God the doctor took that decision to use this machine," said Tania's mother, Antonieta Oropeza, speaking in Spanish through an interpreter.

EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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