Innovative Management of Refractory Hypoxemia in Severe H1N1 Acute Respiratory Distress Syndrome Using Dual Oxygenator and FloTrac-guided Extracorporeal Membrane Oxygenation Flow Modulation: A Case Report

We report a complex case of H1N1-induced severe acute respiratory distress syndrome (ARDS) in a 58-year-old male complicated by viral myocarditis, multiorgan failure, and refractory hypoxemia despite standard venovenous extracorporeal membrane oxygenation (VV ECMO) support.A novel approach employing dual oxygenators and FloTrac-guided ECMO flow modulation successfully managed persistent hypoxemia.Immunomodulation with tocilizumab addressed the cytokine storm effectively.This case highlights personalized ECMO management, multiorgan supportive strategies, and dedicated multidisciplinary teamwork.