Paradigm Shift Intervention Monitoring
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Commentary
Eight pH1N1 Pittsburgh
Patients On ECMO Machines
Recombinomics Commentary 22:45
January 6, 2014
At UPMC Presbyterian in Oakland, the treatment machine known as extracorporeal membrane oxygenation, or ECMO, has been used on four patients, said Dr. Donald Yealy, UPMC's chief of emergency medicine.
Yealy said patients treated with the machines are experiencing “the most serious complications short of death.”
At least five other patients at UPMC were critically ill but did not require treatment with ECMO machines.
The above comments describe the status of 13 H1N1 cases at two Pittsburgh hospitals, where one additional patient (62F) has died (see map) This high number of critically ill patients is being reported two weeks after the number of confirmed cases in Pennsylvania has begun to rise. Allegheny county has reported 149 confirmed H1N1 cases and the ILI level for Pennsylvania in the week 52 FluView was moderate (6 on a scale of 10). In spite of these relatively low numbers, 14 cases are either dead (1), on ECMO machines (8), or critically ill (5). Moreover, the fatal case (62F) was described as “an older woman” suggesting most or all of the above hospitalized are young or middle aged adults.
The high frequency of severe and fatal cases raises concerns that the death toll will dramatically increase in upcoming weeks, raising concerns the quasi-species of receptor binding domain changes (D225G/N, Q226R, and L194I) or oseltamivir resistance (H274Y) is common (see map), leading to have viral loads in the lungs of these patients (and others in the US, see Texas map, and Canada), leading to unfavorable outcomes.
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