ECMO and HCPS

Q: Extracorporeal membrane oxygenation (ECMO) has shown no survival benefit in Hantavirus Cardiopulmonary Syndrome (HCPS) and should be considered only when death seems to be the probable outcome.

A) True

B) False

Answer: B

Early insertion of vascular sheaths and preemptive cannulation are associated with a higher survival rate, up to 65-80%, in HCPS. Mortality seems to increase once hemodynamic instability occurs later in the course.

Evidence showed that if a cardiac index remained below 2.5 L/minute/m2 despite volume, pressor, and inotropic support, ECMO should be pursued early in the course. 

Interestingly, ECMO in HCPS has been known to be beneficial for the last three decades (reference #1).

#hemodynamics

#ID

References:

1. Crowley MR, Katz RW, Kessler R, et al. Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. Crit Care Med 1998; 26:409.

2. Wernly JA, Dietl CA, Tabe CE, et al. Extracorporeal membrane oxygenation support improves survival of patients with Hantavirus cardiopulmonary syndrome refractory to medical treatment. Eur J Cardiothorac Surg 2011; 40:1334.

3. Yao H, McDonald EG. Extracorporeal membrane oxygenation for the treatment of severe refractory hantavirus cardiopulmonary syndrome. CMAJ 2016; 188:E528.