Early corticosteroid in influenza pneumonia related acute respiratory distress syndrome treated with extracorporeal membrane oxygenation

Venovenous extracorporeal membrane oxygenation (ECMO) has been used as a rescue therapy for acute respiratory distress syndrome (ARDS) and prolonged use is not uncommon. The clinical significance of the inflammation triggered by ECMO and whether to treat it has remained unclear. This is a retrospective observational survey conducted in a medical center in Taiwan, including patients with influenza pneumonia-related ARDS treated using ECMO from 2009 to 2016. The purpose of this study was to evaluate the relation between corticosteroid use and their clinical outcomes. Among the 37 patients enrolled, 33 had a confirmed influenza infection, predominantly with type A viruses (87.9%). Four patients (10.8%) had early bacterial co-infections within the first three hospital days. All patients received systemic corticosteroid for a median duration of 13.5 days. The median initial daily dose was equivalent to 1.0 mg/kg of methylprednisolone and it was initiated within a median of 1 day after intubation. Thirteen patients (35%) survived to discharge. In univariate analysis, early co-infection, pneumothorax, and new hemodialysis were more common among non-survivors (p ≤ 0.05). Patients who received steroid within 72 hours of intubation were less likely to survive to discharge (p = 0.02) and more likely to have bloodstream infections during hospitalization (p = 0.04).