To the Editor: As the world struggles with the challenges of influenza A pandemic (H1N1) 2009, it is clear that treatment options for critically ill infected patients are suboptimal because deaths continue to be reported in otherwise young and healthy patients. Extracorporeal membrane oxygenation (ECMO) is an established therapeutic option for patients with medically refractory cardiogenic or respiratory failure. We describe the successful use of ECMO in a patient with complicated pneumonia and influenza A pandemic (H1N1) 2009 virus infection. Our patient, a 21-year-old woman who was 4 months postpartum, had poorly controlled insulin-dependent diabetes (hemoglobin A1C level 13.2 mg/dL). She sought treatment at another hospital after 3 days of respiratory symptoms, a productive cough after working in her garden, and a fever>103°F. Her condition rapidly deteriorated, and she required mechanical ventilation, vasoactive medications, and drotecogin-α (Xigris; Eli Lilly and Company, Indianapolis, IN, USA) for profound shock. The patient was then transferred to Ohio State University Medical Center on August 24, 2009; at admission she exhibited hypotension (83/43 mm Hg) and tachycardia (159 bpm), despite having received high doses of vasoactive medications (norepinephrine 1.0 μg/kg/min, phenylephrine 2.0 μg/kg/min). A transthoracic echocardiograph showed severe biventricular failure (ejection fraction 5%–10%); peak tropinin level was 6 mg/dL. Arterial blood gas confirmed metabolic acidosis (pH 7.12, partial carbon dioxide pressure [pC
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