Hantavirus cardiopulmonary syndrome: half of those supported needed ECMO

Design

National retrospective cohort using diagnosis-related group administrative data, stratified by maximal respiratory support

Population

215 patients with hantavirus cardiopulmonary syndrome admitted to 31 Chilean hospitals, 2019-2024; 69.3% male, 87% adults

Primary outcome

Hospital length of stay and in-hospital mortality

Effect

148 required respiratory support: 14.2% non-invasive ventilation, 36.5% invasive ventilation, 49.3% ECMO. Median stay 8 days (IQR 3-15). Mortality 20.5% overall, 29.6% with mechanical ventilation, 32.9% with ECMO. Pandemic period adjusted odds ratio for death 2.73 (95% CI 1.06-7.63)

Andes virus causes hantavirus cardiopulmonary syndrome in Chile and Argentina, and a recent cruise ship outbreak made contemporary data on what these patients actually need more than academic. This analysis of a national diagnosis-related group database covered 215 patients admitted to 31 Chilean hospitals between 2019 and 2024, stratified by the maximum respiratory support they received.

One hundred and forty-eight needed respiratory support. Of those, 14.2% were managed with non-invasive ventilation, 36.5% with invasive mechanical ventilation, and 49.3% required extracorporeal membrane oxygenation — a striking proportion, and one that tells you what kind of facility these patients need to reach. Median hospital stay was 8 days. In-hospital mortality was 20.5% overall, 29.6% in those mechanically ventilated and 32.9% in those on ECMO.

The pandemic period carried independently higher mortality (adjusted odds ratio 2.73, 95% CI 1.06-7.63), which the authors attribute to the period rather than to any change in the virus — a reminder that a stretched system kills patients in diseases unrelated to the one stretching it.

For clinicians outside South America the transferable content is the shape of the illness: a febrile prodrome followed by rapid cardiopulmonary collapse with capillary leak, in which the decisive question is whether ECMO is reachable in time.

• Recognise the biphasic pattern: febrile prodrome then abrupt cardiopulmonary deterioration
• Identify ECMO availability and transfer routes early, not at the point of failure
• Expect capillary leak; large-volume crystalloid resuscitation may worsen pulmonary oedema
• Note that mortality rose during the pandemic period, independent of case severity
• Andes virus is confined to Chile and Argentina; other hantaviruses cause different syndromes

Why it matters

It quantifies what level of organ support this infection actually demands, which is what determines where a patient should be sent.

Don't overread it

This is administrative database analysis; coding accuracy and unmeasured severity differences between periods cannot be excluded.

The statistics, in plain English

These proportions describe patients who reached hospital and were coded for the diagnosis; milder cases managed without admission are invisible, so the 20.5% mortality is not a case fatality rate for the infection. The pandemic odds ratio has a wide interval (1.06 to 7.63) and only just clears 1.0, so the direction is more reliable than the magnitude. Administrative database coding cannot confirm the diagnosis or capture the timing of deterioration.

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