H1N1 Swine Flu - A Case Study

Summary: If you test negative for H1N1, consider treatment for influenza anyway.  If needed, the University of Michigan has a mobile ECMO team.

Albert, a 50 year old man with a history of cancer presented at a cancer hospital with a 103+ degree temperature.  Upon presenting at the hospital a complete diagnostic exam was conducted and Albert was admitted to the hospital because the source of the ailment could not be identified.

While hospitalized, two tests for the H1N1 virus were conducted via an oral swab, but both results were negative.  A third test, conducted two weeks later via a scraping of the lungs, resulted positive for the H1N1 virus.   Why the false negative results?  Quoting the Centers for Disease Control and Prevention (the CDC):

 When treatment of influenza is indicated in a patient with suspected influenza, health care providers should initiate empiric antiviral treatment as soon as possible. Waiting for laboratory confirmation of influenza to begin treatment with antiviral drugs is not necessary. Patients with a negative rapid influenza diagnostic test should be considered for treatment if clinically indicated because a negative rapid influenza test result does not rule out influenza virus infection. The sensitivity of rapid influenza diagnostic tests for 2009 H1N1 virus can range from 10% to 70%, indicating that false negative results occur frequently.”

 

Because of the false negative H1N1 test results, a proper diagnosis was not obtained until the third week.  During the three weeks Albert’s condition deteriorated and the patient developed ARDS.  The hospital, dedicated to cancer, placed Albert on a ventilator and later used high-frequency oscillation but to no avail, Albert’s condition was deteriorating.

At the onset of the ailment the family contacted HealthCare Advocates but did not engage us until the fourth week of the hospitalization.  When the family finally engaged HealthCare Advocates, Albert’s medical condition was reviewed.   HealthCare Advocates researched the issues and found that extracorporeal membrane oxygenation (ECMO) resulted in increased survival rates.  In fact, the Glenfield/Heartlink study indicated a 72% mortality rate for people who were referred to ECMO but did not receive ECMO. 

After researching treatment options HealthCare Advocates found that the hospital had never offered ECMO as a treatment option.  The reason it was not offered is because, like most hospitals, the hospital did not have an ECMO machine.  In fact, most major cities only have a couple of hospital equipped with an ECMO machine. 

Because the hospital did not have an ECMO machine the logical conclusion was to transfer Albert to a hospital that had an ECMO machine.  The problem with transferring Albert was the lung saturation and low blood pressure would have resulted in death.  Understanding that obstacle, HealthCare Advocates sought alternatives to the ECMO machine; these alternatives were rejected by the family.  Note: HealthCare Advocates tried to obtain an ECMO machine from other hospitals but all efforts were denied as had been anticipated.

HealthCare Advocates continued work and found an ambulatory ECMO team.  The University of Michigan has an ECMO team that will fly to the patient’s location, stabilize the patient, and fly the patient back to the University of Michigan on an ECMO machine.  HealthCare Advocates received this case on a Friday and had this solution in place by Tuesday.  Unfortunately the patient passed away that Tuesday. 

Following Albert’s death the family called and said, “had we engaged HealthCare Advocates four weeks earlier when we originally contacted you, Albert would still be alive.  Your firm was able to present the solutions that would have likely meant the difference between life and death, I am sorry the other family members made poor decisions and were slow in reacting.”

HealthCare Advocates (Your Ally in Healthcare):
Telephone # 215-735-7711
Email: info @ healthcareadvocates.com
URL: www.healthcareadvocates.com

Sources:
CDC on H1N1 test results : http://www.cdc.gov/H1N1flu/HAN/101909.htm
Jama on ECMO: http://jama.ama-assn.org/cgi/content/full/2009.1535

by Kevin Flynn, et al
Dated: 2010

 

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