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Austin H1N1 ECMO Machines Maxed Out
Recombinomics Commentary 12:00
December 26, 2013

Seton officials say in the last two weeks the number of flu patients doubled from about 200 to 400 confirmed cases. And five patients with the H1N1 virus were put on a special heart-lung machine to help them breathe.

Weingarten says the procedure is complex and often requires a team of over 35 physicians, nurses, perfusionists, and respiratory therapists for each individual ECMO case, which does not include the team of lab technicians that provide critical life-saving patient information. Patients require 24-hour care while they are connected to the device, which may last a few days or several weeks.

The above comments are from media reports of a press conference at Seton Medical Center on December 24, updating the H1N 1 situation in Austin, Texas (see map), which serves central Texas, with a modern center that includes 5 EMCO machines, which require significant resources, as noted above.

EMCO machines are used for H1N1 patients who can no long breathe on their own or oxygenate their blood.  These functions are assumed by the ECMO machine in a last ditch effort to allow the patient to repair the extensive lung damage and associated complications.

The presentations cited a case in 2012 who was 8 months pregnant when infected with H1N1.  After delivery of a healthy baby by C-section the patient recovered after four weeks on an ECMO machine.  As noted above in the current outbreak, five patients were hooked up to the five machines at Seton (and a sixth machine was kept in reserve to substitute for a machine that loses functionality during treatment).  One of those five cases had been recently taken off the machine, but as noted above, the number of flu patients has doubled in the past week, raising concerns that the ECMO resource will be taxed significantly.

The five patients were between ages in the 20’s to 50’s (1 twenties, 3 forties, 1 fifties) and did not have pre-existing conditions, other than obesity.  In addition to the five adult patients on ECMO machines, one child (10M) had just come off an ECMO machine at the affiliated Dell Children’s Hospital.  In addition to the six cases cited above, two pregnant women had died, and many additional middle age and young adults were in ICUs at Austin area hospitals.

This concentration of severe H1N1 cases in the Austin area has raised concerns that the current outbreak will be more severe than 2009.  Although adult deaths are not reportable, a Texas summary of H1N1 in 2009-2010 cited 240 deaths in Texas, which was concentrated in cases <65.  The current outbreak is clearly targeting this population, raising concerns that the virus has drifted away from the 2009 version, leading to its dominance in Texas and across North America.

The early numbers in Austin raise concerns that these cases will tax health care delivery.  There have already been shortages on vaccine and Tamiflu reported in the area.  Both items are not in short supply nationwide, and the current demand in Austin has led to delays in distribution, but there a no nationwide or statewide shortages at this time.
However, the 2013 outbreak is about 3 months behind 2009, raising concerns that the current outbreak will peak in February, when conditions favor the spread of influenza.

Release of sequences from severe and fatal cases in eastern Texas would be useful.

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