Philippe Biderman1, Sharon Einav, Michael Fainblut, Michael Stein, Pierre Singer, Benjamin Medalion. 1. From the Department of Cardiothoracic Surgery (P.B., M.F., B.M.), Trauma Unit (M.S.), and Department of General Intensive Care (P.S.), Rabin Medical Center, Tel-Aviv University, Tel-Aviv; and General Intensive Care Unit (S.E.), Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel.
Abstract
BACKGROUND: The use of extracorporeal life support in trauma casualties is limited by concerns regarding hemorrhage, particularly in the presence of traumatic brain injury (TBI). We report the use of extracorporeal membrane oxygenation (ECMO)/interventional lung assist (iLA) as salvage therapy in trauma patients. High-flow technique without anticoagulation was used in patients with coagulopathy or TBI. METHODS: Data were collected from all adult trauma patients referred to one center for ECMO/iLA treatment owing to severe hypoxemic respiratory failure. RESULTS: Ten casualties had a mean (SD) Injury Severity Score (ISS) of 50.3 (10.5) (mean [SD] age, 29.8 [7.7] years; 60% male) and were supported 9.5 (4.5) days on ECMO (n = 5) and 7.6 (6.5) days on iLA (n = 5). All experienced blunt injury with severe chest injuries, including one cardiac perforation. Most were coagulopathic before initiation of ECMO/iLA support. Among the seven patients with TBI, four had active intracranial hemorrhage. Complications directly related to support therapy were not lethal; these included hemorrhage from a cannulation site (n = 1), accidental removal of a cannula (n = 1), and pressure sores (n = 3). Deaths occurred owing to septic (n = 2) and cardiogenic shock (n = 1). Survival rates were 60% and 80% on ECMO and iLA, respectively. Follow-up of survivors detected no neurologic deterioration. CONCLUSION: ECMO/iLA therapy can be used as a rescue therapy in adult trauma patients with severe hypoxemic respiratory failure, even in the presence of coagulopathy and/or brain injury. The benefits of rewarming, acid-base correction, oxygenation, and circulatory support must be weighed individually against the risk of hemorrhage. Further research should determine whether ECMO therapy also confers survival benefit. LEVEL OF EVIDENCE: Therapeutic study, level V.
BACKGROUND: The use of extracorporeal life support in trauma casualties is limited by concerns regarding hemorrhage, particularly in the presence of traumatic brain injury (TBI). We report the use of extracorporeal membrane oxygenation (ECMO)/interventional lung assist (iLA) as salvage therapy in traumapatients. High-flow technique without anticoagulation was used in patients with coagulopathy or TBI. METHODS: Data were collected from all adult traumapatients referred to one center for ECMO/iLA treatment owing to severe hypoxemic respiratory failure. RESULTS: Ten casualties had a mean (SD) Injury Severity Score (ISS) of 50.3 (10.5) (mean [SD] age, 29.8 [7.7] years; 60% male) and were supported 9.5 (4.5) days on ECMO (n = 5) and 7.6 (6.5) days on iLA (n = 5). All experienced blunt injury with severe chest injuries, including one cardiac perforation. Most were coagulopathic before initiation of ECMO/iLA support. Among the seven patients with TBI, four had active intracranial hemorrhage. Complications directly related to support therapy were not lethal; these included hemorrhage from a cannulation site (n = 1), accidental removal of a cannula (n = 1), and pressure sores (n = 3). Deaths occurred owing to septic (n = 2) and cardiogenic shock (n = 1). Survival rates were 60% and 80% on ECMO and iLA, respectively. Follow-up of survivors detected no neurologic deterioration. CONCLUSION: ECMO/iLA therapy can be used as a rescue therapy in adult traumapatients with severe hypoxemic respiratory failure, even in the presence of coagulopathy and/or brain injury. The benefits of rewarming, acid-base correction, oxygenation, and circulatory support must be weighed individually against the risk of hemorrhage. Further research should determine whether ECMO therapy also confers survival benefit. LEVEL OF EVIDENCE: Therapeutic study, level V.
Authors: Jonathan D Marhong; Laveena Munshi; Michael Detsky; Teagan Telesnicki; Eddy Fan Journal: Intensive Care Med Date: 2015-03-10 Impact factor: 17.440
Authors: Jay Menaker; Ronald B Tesoriero; Ali Tabatabai; Ronald P Rabinowitz; Christopher Cornachione; Terence Lonergan; Katelyn Dolly; Raymond Rector; James V O'Connor; Deborah M Stein; Thomas M Scalea Journal: World J Surg Date: 2018-08 Impact factor: 3.352
Authors: Martin Gothner; Dirk Buchwald; Justus T Strauch; Thomas A Schildhauer; Justyna Swol Journal: Scand J Trauma Resusc Emerg Med Date: 2015-03-28 Impact factor: 2.953
Authors: Kun Il Kim; Hee Sung Lee; Hyoung Soo Kim; Sang Ook Ha; Won Yong Lee; Sang Jun Park; Sun Hee Lee; Tae Hun Lee; Jeong Yeol Seo; Hyun Hee Choi; Kyu Tae Park; Sang Jin Han; Kyung Soon Hong; Sung Mi Hwang; Jae Jun Lee Journal: Scand J Trauma Resusc Emerg Med Date: 2015-08-17 Impact factor: 2.953