Temporary extracorporeal membrane oxygenation in the treatment of acute traumatic lung injury.

PURPOSE: To report two cases of acute life-threatening traumatic lung injury, who required temporary extracorporeal veno-venous membrane oxygenation (ECMO), and airlifting to a level I trauma centre. CLINICAL FEATURES: The first patient suffered a severe motor vehicle accident with prolonged entrapment in the wreckage. After extrication, tracheal intubation, and fluid resuscitation, respiratory therapy failed to result in sufficient ventilation and oxygenation within the first hours after trauma due to severe lung contusion and intraparenychmal bleeding. The second patient was hit by a falling tree and suffered isolated blunt chest trauma. Due to pulmonary contusions and tracheal rupture, subsequent ventilation management was limited by extensive mediastinal emphysema. Both patients were airlifted to a University Hospital and placed on ECMO for four and six days without complications, respectively. After emergency surgery and 21 and 26 days intensive care treatment, both patients were transferred to a general ward, and discharged from the hospital with full recovery.
CONCLUSION: These cases demonstrate the role of ECMO in the treatment of traumatic respiratory failure. If ventilatory support strategies fail due to severe lung or airway injury, ECMO may be an option for the temporary management of gas exchange in trauma patients.