A revolutionary new treatment in a dangerous flu season

The annual scourge known as the flu is always a serious health threat, and this season's version is particularly nasty.

Not yet at its peak, the 2014-15 influenza season has already killed at least 36 people in Pennsylvania and rendered nearly 20,000 others into aching, feverish wretches, gasping for breath.

The incidence of flu was high in Central and Northern New Jersey and moderate in the southern counties during the first week of January, the New Jersey Department of Health reported.

The traditional armamentarium to treat flu victims is relatively limited, said David Oxman, a critical care and infectious disease doctor at Thomas Jefferson University Hospital.

The drug Tamiflu may (or may not) help speed recovery a little. Antibiotics are used when patients develop bacterial infections and pneumonia. And in grave cases, patients might need to be heavily sedated or chemically paralyzed, and put on ventilators for several weeks.

For about a year, however, Jefferson also has offered severely ill patients a new, potentially lifesaving treatment.

"Here is the heart of it," said Nicholas Cavarocchi, professor of cardiothoracic surgery at Jefferson. He patted a small metal box placed at the far end of a room in one of the hospital's intensive care units. Long plastic tubes filled with blood snaked in and out of the box, connecting to a hulking contraption reminiscent of the sci-fi beds that space travelers seal themselves in for extended intergalactic naps.

The patient was lying face down, cocooned in thick blue plastic padding that covered everything head to toe, except a small portion of the back of the skull.

Mechanically, Cavarocchi explained, this treatment is not much different from traditional ECMO, the merciful acronym for "extracorporeal membrane oxygenation."

ECMO works as a kind of dialysis for the lungs. The patient's blood circulates through the machine, where it is infused with oxygen, filtered, then pumped back into the body, allowing damaged lungs time to recover.

Until 2009, ECMO was rarely used to treat adults. During the H1N1 flu epidemic that year, however, investigators in Australia and New Zealand tried it as "salvage therapy" and reported a 70 percent survival rate.

"It is still debatable how much of a survival benefit over conventional mechanical ventilation ECMO offers," said Oxman. "That being said ... most clinicians believe that some sizable proportion of those patients put on ECMO would have died otherwise."

A growing number of hospitals are using ECMO to treat critically ill flu patients and others with serious respiratory conditions. For several years, Jefferson has provided a mobile ECMO unit to transfer patients on advanced life-support.

Meanwhile, Cavarocchi has been experimenting with a way to improve patient outcomes with ECMO.

As long as patients are lying on their backs, he said, no amount of suctioning will completely remove the fluid pooling deep in the lungs.

"Proning," or placing the patients face down while they are on ventilators, had been used for years to help address this problem, particularly with children. But it is not often used with ECMO and rarely with the sort of modernized, automated equipment in use at Jefferson.

Working with several colleagues, Cavarocchi devised a way to suspend patients on their bellies while they are attached to the ECMO device. Since late 2013, he said, they have treated about 20 patients.

"We are compiling the data," Cavarocchi said. "There have been lots of successes. It appears to have shortened the length of time required for the lungs to heal."

Fortunately, relatively few people who get the flu will need to be hospitalized, let alone receive this kind of treatment, said Oxman.

Still, flu needs to be taken seriously, he said. And although it is too soon to officially declare this flu season a whopper, early indications point to a fair amount of misery.

The winter's reigning strain - H3N2 - has been mutating since last spring, making the vaccine less effective than hoped.

As of Jan. 3, the Pennsylvania Department of Health reported 17,986 cases of flu in the state, considerably higher than the 3,800 cases reported last year at this time, said Holli Senior, a department spokeswoman. Last year's flu peaked earlier, accounting for some of that difference. Still, Senior said, "it's a pretty severe flu season. And it doesn't help that the dominating strain is an A strain, in which the symptoms can be more severe."

The Centers for Disease Control and Prevention reports that during years when the predominant strain has been H3N2, people have become sicker and more have died.

Between 1976 and 2007, for example, CDC estimates that an average of 28,909 people died from flu during H3N2 seasons, compared with 10,648 people during non-H3N2 predominant years.

Reports that this season's vaccine is not effective are misleading, Senior said: "The reality is, you still may get some protection and have a milder case than you might have had otherwise."

And some protection is far better than none, she said, emphasizing that it still is not too late.

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