The severity of novel influenza A virus subtype H1N1 in young adults was initially described by the Mexican Health Ministry in April 2009 (1). The number of previously healthy patients progressing to respiratory and multisys-

70 The severity of novel influenza A virus subtype H1N1 in young adults was initially described by the Mexican Health Ministry in April 2009 (1). The number of previously healthy patients progressing to respiratory and multisystem organ failure was common (2,3). Worldwide, hospitals reported surges in intensive care admissions during the initial phase of the pandemic (4–6). In Canada, 17% of all hospitalized patients were admitted to the intensive care unit and suffered a mortality rate approaching 5% (6). In patients with H1N1 pneumonia refractory to mechanical ventilation, some centers were reporting low survival rates despite the use of extracorporeal membrane oxygenation (ECMO). The initial poor outcomes and protracted ECMO treatment epochs resulted in centers limiting or withholding the use of ECMO in this population. With respect to children with H1N1 infection there was also uncertainty concerning optimal incorporation of ECMO as a therapeutic option. Previously, in children with rapidly progressive pneumonia and hypoxia refractory to mechanical ventilation, venovenous (VV) ECMO has been successfully used with survival ranging from 40–60% depending on the etiology (7). We report the successful use of VV ECMO in two children with confirmed novel H1N1 complicated by bacterial pneumonia or morbid obesity.