In early 2009, a novel strain of influenza, swine origin influenza A/H1N1 infection (H1N1) emerged in swine and rapidly spread to humans [6] . Originating in Mexico, the strain proved highly infectious and was spread by person-to-person contact with a predilection for younger hosts. While early epidemiologic data suggested that although H1N1 was highly infectious, it was less virulent [7, 8] than anticipated with a case fatality rate of approximately 0.5% of infected individuals. For the majority of infected individuals, symptoms were mild and selflimited; however, a small percentage of infected individuals developed profound respiratory failure requiring extraordinary means of oxygenation support including high frequency oscillation (HFO) ventilation and extracorporeal membrane oxygenation (ECMO) [9] . Caring for the most severely ill patients during a pandemic results in an increased need for intensive care unit (ICU) resources and strains available personnel and equipment. There is little excess capacity to care for critically ill patients in most developed countries, and minimal capacity in developing countries.