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Lung treatment for swine flu patients

Patients with swine flu who experience severe respiratory failure should be given a specialist lung treatment, researchers said today.

The treatment saves one extra life for every six patients compared with conventional treatment for those who are critically ill.

It is called extracorporeal membrane oxygenation (ECMO) and involves circulating the patient's blood outside the body and adding oxygen to it artificially.

The research, published in The Lancet medical journal, said patients with severe but potentially reversible respiratory failure should be treated with ECMO to “significantly improve survival without severe disability”.

The Government's chief medical officer Sir Liam Donaldson said opinion on the treatment's value for adult patients was “divided”.

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Dr Giles Peek, from the ECMO unit at Glenfield Hospital, who led the study, said there was likely to be a “big increase” in the need for ECMO as swine flu enters its second wave this autumn.

“That's certainly what happened in Australia last year,” he said.

“They were quite sceptical of ECMO at first but they did 60 patients between Australia and New Zealand. The combined population of Australia and New Zealand is a fraction of the population here.

“I think it's clear there will be an increased need for ECMO in the UK.”

The trial run by Dr Peek and colleagues showed that 63% of patients given ECMO survived to six months without disability compared with 47% of those who were assigned to conventional treatment with a ventilator.

Dr Peek said Sir Liam was reflecting the scepticism felt about ECMO in some parts of the intensive care community.

But he said this was because some units had “dabbled” with ECMO without proper training and had had little success.

Asked if he was concerned there would not be enough ECMO beds for swine flu patients this winter, he said: “Yes and no. It depends on the Government's approach.

“If the chief medical officer is rubbishing (the research), I don't think we are going to have an informed approach.”

He estimated that around 100 patients had been treated with ECMO in other hospitals with no survivors.

Dr Peek said he wanted the Government to resource ECMO properly so there could be an expansion of the number of beds this winter if needed.

There could be a “hub and spoke” situation where Leicester could provide support to other hospitals wishing to treat patients with ECMO, he said.

“If hospitals are going to provide it, they should be in the loop rather than going it alone.

“It's a case of being resourced.

“It needs to be coherent, national and inclusive rather than people going off on their own.”

In Leicester, of 13 swine flu patients treated so far with ECMO, 85% have survived.

“Most swine flu patients are young so you would expect them to do better,” Dr Peek said.

ECMO units for children are based in specialist neonatal units in Great Ormond Street Hospital, Freeman Hospital in Newcastle upon Tyne, and Yorkhill Hospital in Glasgow.

Sir Liam has admitted that ECMO is a “well established technique in children”.

In the latest trial, 180 adults were divided into two groups, with half receiving ECMO and half receiving conventional ventilation.

The patients were aged between 18 and 65 and had severe but potentially reversible respiratory failure.

The researchers found that 68 of the 90 patients (75%) considered for ECMO actually received it.

Of these, 63% survived to six months without disability compared with 47% of those who were assigned to conventional management.

The cost of ECMO was twice that of conventional treatment.

But the authors wrote: “The cost-effectiveness of ECMO would be improved if costs of both transport and provision of the technique could be reduced.

“We are confident that ECMO is a clinically effective treatment for acute respiratory distress syndrome, which also promises to be cost-effective in comparison with other techniques competing for health resources.”

Dr Peek added: “Swine flu causes a viral pneumonia which can result in severe respiratory failure in young adults. We have already used ECMO during the first wave of the pandemic with good effect and we are expecting ECMO to prove an invaluable weapon in the fight against the winter resurgence of the infection, as has already been seen during the Australasian winter.”

In an accompanying comment piece in The Lancet, doctors from the US said: “This study will likely provide ammunition for both those in favour and those against the use of ECMO in the adult population.”

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