Thay-Hsiung Chen1, James Yao-Ming Shih2, Joseph Juey-Ming Shih3. 1. Division of Cardiovascular Surgery, Cathay General Hospital; ; College of Medicine, Taipei Medical University, Taipei; ; Fu Jen Catholic University, New Taipei City; 2. Surgical Intensive Care Unit, Department of Surgery, Cathay General Hospital, Taipei; 3. Surgical Intensive Care Unit, Department of Surgery, Sijhih Cathay General Hospital, New Taipei City, Taiwan.
Abstract
BACKGROUND: The objective of this study was to assess the feasibility and safety of heparin-free veno-venous extracorporeal life support (VV ECLS) as a means of salvaging polytrauma patients with life-threatening hypoxemia. METHODS: This is a retrospective observational study on 7 consecutive trauma patients who underwent VV ECLS for severe chest trauma unresponsive to conventional measures. RESULTS: The median time to ECLS was within 10 hrs (IQR 2-53) of mechanical ventilation. Surgical interventions were performed before and during ECLS based on management priorities consistent with advanced trauma life support guidelines. No heparin was used for at least 4 days in this group with activated coagulation time (ACT) approximating 170 seconds by the 3(rd) and 4(th) day. There were no thromboembolic complications. Four patients were successfully discharged and three of these survivors had concomitant traumatic brain injury (TBI) without neurologic sequel. CONCLUSIONS: Early VV ECLS can be used for salvage of patients with traumatic lung injury. Acute trauma care can be continued as needed under heparin-free ECLS without the fear of thromboembolic complications. KEY WORDS: Adult respiratory distress syndrome; Extracorporeal life support; Multiple trauma; Thoracic injury; Traumatic brain injury.
BACKGROUND: The objective of this study was to assess the feasibility and safety of heparin-free veno-venous extracorporeal life support (VV ECLS) as a means of salvaging polytraumapatients with life-threatening hypoxemia. METHODS: This is a retrospective observational study on 7 consecutive traumapatients who underwent VV ECLS for severe chest trauma unresponsive to conventional measures. RESULTS: The median time to ECLS was within 10 hrs (IQR 2-53) of mechanical ventilation. Surgical interventions were performed before and during ECLS based on management priorities consistent with advanced trauma life support guidelines. No heparin was used for at least 4 days in this group with activated coagulation time (ACT) approximating 170 seconds by the 3(rd) and 4(th) day. There were no thromboembolic complications. Four patients were successfully discharged and three of these survivors had concomitant traumatic brain injury (TBI) without neurologic sequel. CONCLUSIONS: Early VV ECLS can be used for salvage of patients with traumatic lung injury. Acute trauma care can be continued as needed under heparin-free ECLS without the fear of thromboembolic complications. KEY WORDS: Adult respiratory distress syndrome; Extracorporeal life support; Multiple trauma; Thoracic injury; Traumatic brain injury.
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