Influenza triggers respiratory failure: Hannah’s temporary lung

After influenza triggered severe respiratory failure in three-year old Hannah, an interdisciplinary ECMO team brought the little girl to Erlangen for treatment.

“I saw the X-ray of her lungs,” reports Hannah’s mother, Laura C., who is also a nurse. “And I knew straight away what it meant: all white. Basically no gas exchange at all anymore.” All the doctor said was ‘I’m sorry.’” Three-year old Hannah was being treated at the hospital in Chemnitz at the time, in February 2025, although really only for a small abscess. However, she started to develop severe symptoms of influenza, progressing all the way to severe respiratory failure. Hannah’s last chance: extracorporeal membrane oxygenation (ECMO), or ECMO for short. During this procedure, blood is oxygenated outside of the body. This treatment was not available in Chemnitz, But a specially-trained team from Uniklinikum Erlangen made its way to Saxony to connect the little girl suffering from the life-threatening condition to ECMO, and transport her to Franconia for continuing care. Hannah made it, but she is still recovering from her illness.

“It was hard,” says Laura C., her voice breaking. “At first I thought she was going to be put on a ventilator for two days to let her lung recover. But then each day the news got worse and worse. In Chemnitz, she was moved first from acute care to the intensive care ward, where she was ventilated at first non-invasively and then invasively, and her lung kept deteriorating.” According to Prof. Dr Heiko Reutter, Head of Neonatology and Pediatric Intensive Care at the Department of Paediatrics and Adolescent Medicine (director: Prof. Dr. Joachim Wölfle) at Uniklinikum Erlangen, “we have never treated as many children with influenza in Erlangen as we did during the influenza season 2024/2025, and several of them even had to be treated in intensive care.”

Suddenly, everything had to happen in a rush for the little girl from Saxony. “The hospital contacted several hospitals throughout Germany,” Hannah’s mother remembers. “In Erlangen they immediately agreed to come and pick her up.” Pediatric intensive care specialist Prof. Reutter, pediatric cardiac surgeon Dr. Ehab Nooh, perfusionist Nicola Kwapil and nurse Eva Schatz from Pediatric Intensive Care set off together on the approximately 250 kilometer long journey to the hospital in Chemnitz. “I was well aware that things had to move quickly if Hannah was to survive,” remembers Laura C. “Once Professor Reutter and his team finally arrived, I knew that she was in good hands. My sister agreed that Hannah was now in the right place, and what she now needs is time to recover and get her strength back.”

Challenging: ECMO with children

The veno-venous ECMO Hannah received supports the lung outside the body, for example in the case of severe respiratory failure, pneumonia, or sepsis. Oxygen-poor blood is taken out of the body and oxygenated in the ECMO system. Prof. Reutter describes the challenge: “All anatomic structures in children, for instance their veins, are much smaller. For this reason, we use ultrasound scans to ensure that the cannula from the ECMO really has been placed correctly. It should go via the right atrium of the heart into the inferior caval vein, where oxygen-poor blood is collected, before being oxygenated and returned to the right atrium.”

Perfusionist Nicola Kwapil from the Department of Pediatric Cardiac Surgery at the Department of Cardiac Surgery (director: Prof. Dr. Oliver Dewald) from Uniklinikum Erlangen selected the suitable oxygenator for Hannah. He took a mobile transport set suitable for children to Chemnitz, connected the little girl up to the ECMO with the help of doctors and adjusted parameters such as blood and gas flow and oxygenation to suit Hannah’s situation. “As children have a higher thrombosis risk, the doctors and I always keep an eye on blood coagulation and use anticoagulant medication,” the perfusionist explains. It is possible to accurately regulate the amount of blood flowing through the ECMO pump each minute. The doctors monitor their little patients’ vital signs and work closely with the perfusionist to regulate how much oxygen is transferred to the blood and how much carbon dioxide is removed. At the same time, patients are given gentle mechanical ventilation to spare their lungs and give them time to heal. The Erlangen specialists provide veno-venous ECMO to children of all ages, even newborn infants. Specially-trained pediatric nurses care for the ECMO patients with expertise and compassion.

New service: intensive care transport to Erlangen

“Just as we collected Hannah in our specialized intensive care ambulance, we intend to offer this service in future to all children suffering from severe respiratory failure who can no longer be ventilated,” explains Prof. Dr. Oliver Dewald, director of Cardiac Surgery at Uniklinikum Erlangen. “Our ECMO team of four specialists will concentrate particularly on hospitals in southern and central Germany. They can contact us whenever they have patients requiring assistance.” A high degree of expertise and experience is required to use ECMO on children and young people. “We have offered our services for adults for quite some time now, but the procedure is still new for children, and we are one of the few teams in Germany to offer it. This makes it all the more important that we do,” explains Prof. Dewald. Unlike veno-venous ECMO that purely serves to assist the lungs, as in Hannah’s case, a second type, known as veno-arterial ECMO also supports the heart. “This veno-arterial ECMO may be necessary, for example, after cardiac surgery if the organ is not yet working reliably by itself or to support the cardiovascular system after resuscitation. We do also use ECMO at Uniklinikum Erlangen, but when collecting children, we focus exclusively on supporting their lungs,” clarifies Oliver Dewald.

After being gradually weaned off ECMO and ventilation, Hannah still required intensive oxygen therapy. “She basically had to learn to breathe again,” explains Laura C. According to Professor Reutter, “children have an amazing ability to regenerate and we expect her to recover without any lasting side-effects.” “It is always good to hear that,” says Laura C. “However, we will still take time to process what has happened in the last few weeks as a family, and we also intend to seek professional help. It will certainly leave its mark.”

Further information:

Prof. Dr. Heiko Reutter
Phone: +49 9131 85 41360
heiko.reutter@uk-erlangen.de