Impact of early ECMO support on survival of patients with Hantavirus cardiopulmonary syndrome in Chile.

Hantavirus cardiopulmonary syndrome (HCPS) is a zoonosis caused by the Andes virus and it has no specific therapy. The Mortality due to Hantavirus infection is 33,6%, which increases by over 60%-100% in critical illness. Earlier extracorporeal membrane oxygenation (ECMO) support could improve the survival of patients with severe HCPS. Our first aim was to evaluate the impact of ECMO on the survival of patients with HCPS in Chile. We performed an observational study. All patients with clinical suspicion + a rapid test of Hantavirus positive were early transferred, by plane or ambulance, to the ICU of the Instituto Nacional del Tórax, from January 2015 to January 2022. The patients were confirmed by serologic tests or RT-PCR. The patients with critical criteria were connected to ECMO. Demographic, clinical, laboratory, Apache II score, SOFA score, time of transfer to the ICU and ECMO support start time, mechanical ventilation (MV), and hospital survival data were collected. The local ethics committee approved the study. Results: 47 patients were included in the study, mean age was 36 (range, 15-73) years, 68% were men, Apache II: 12.8±7.7 and SOFA: 6.6±3.9. 17 patients underwent early VA-ECMO support, 14 patients required only MV, and 16 oxygen therapy and general care. The time of transfer to the ICU was a median of 10 [4-24] hours, the installation of ECMO time was a median of 6 [1-20,5] hours, and the duration was 133±65 hours. Global hospital survival was 89,4% (42/47) and that’s who required ECMO support was 82,3% (14/17 cases). Conclusion. Early management of patients with HCPS at the national referral center for ECMO and early ECMO support significantly decrease mortality.