1
|
Kim SH, Huh U, Song S, Kim MS, Wang IJ, Tak YJ. Outcomes in trauma patients undergoing veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome. Perfusion 2022:2676591221093880. [PMID: 35678471 DOI: 10.1177/02676591221093880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of veno-venous extracorporeal membrane oxygenation (VV ECMO) remains controversial in trauma patients with acute respiratory distress syndrome (ARDS). Here, we aimed to investigate the therapeutic benefits of VV ECMO and the factors affecting patient outcomes. METHODS From 2017 to 2019, 21/1938 trauma patients (median age: 47 years; 18 men) at a level I trauma center received VV ECMO for post-traumatic ARDS. Demographic, injury-specific, ECMO, and outcome data were prospectively collected and retrospectively reviewed to analyze the factors affecting hospital mortality and ECMO results. RESULTS 19 patients (90.5%) were successfully weaned off ECMO; 16 patients (76.2%) survived to discharge. In univariate analysis, there was a significant difference in survival between the groups with a Trauma and Injury Severity Score (TRISS) ⩾0.5 and TRISS <0.5 (p = 0.05). The area under the receiver operating characteristic curve (AUC) for both TRISS and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores for death was 0.78. In those who failed ECMO weaning, the AUCs of the TRISS and RESP scores were 0.90 and 0.80, respectively. CONCLUSIONS In patients with ARDS caused by severe trauma and supported by VV ECMO, survival is associated with TRISS; TRISS and RESP scores may be predictive of mortality and failure in ECMO weaning.
Collapse
Affiliation(s)
- Seon Hee Kim
- Departments of Trauma Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital Trauma Center, Republic of Korea
| | - Up Huh
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Seunghwan Song
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Min Su Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Il Jae Wang
- Department of Emergency Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Young Jin Tak
- Department of Family Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
| |
Collapse
|
2
|
Willers A, Swol J, Kowalewski M, Raffa GM, Meani P, Jiritano F, Matteucci M, Fina D, Heuts S, Bidar E, Natour E, Sels JW, Delnoij T, Lorusso R. Extracorporeal Life Support in Hemorrhagic Conditions: A Systematic Review. ASAIO J 2021; 67:476-484. [PMID: 32657828 DOI: 10.1097/mat.0000000000001216] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Extracorporeal life support (ECLS) is indicated in refractory acute respiratory or cardiac failure. According to the need for anticoagulation, bleeding conditions (e.g., in trauma, pulmonary bleeding) have been considered a contraindication for the use of ECLS. However, there is increasing evidence for improved outcomes after ECLS support in hemorrhagic patients based on the benefits of hemodynamic support outweighing the increased risk of bleeding. We conducted a systematic literature search according to the PRISMA guidelines and reviewed publications describing ECLS support in hemorrhagic conditions. Seventy-four case reports, four case series, seven retrospective database observational studies, and one preliminary result of an ongoing study were reviewed. In total, 181 patients were identified in total of 86 manuscripts. The reports included patients suffering from bleeding caused by pulmonary hemorrhage (n = 53), trauma (n = 96), postpulmonary endarterectomy (n = 13), tracheal bleeding (n = 1), postpartum or cesarean delivery (n = 11), and intracranial hemorrhage (n = 7). Lower targeted titration of heparin infusion, heparin-free ECLS until coagulation is normalized, clamping of the endotracheal tube, and other ad hoc possibilities represent potential beneficial maneuvers in such conditions. Once the patient is cannulated and circulation restored, bleeding control surgery is performed for stabilization if indicated. The use of ECLS for temporary circulatory or respiratory support in critical patients with refractory hemorrhagic shock appears feasible considering tailored ECMO management strategies. Further investigation is needed to better elucidate the patient selection and ECLS management approaches.
Collapse
Affiliation(s)
- Anne Willers
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Justyna Swol
- Department of Pulmonology, Intensive Care Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Mariusz Kowalewski
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Paolo Meani
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Federica Jiritano
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Matteo Matteucci
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dario Fina
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Samuel Heuts
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Elham Bidar
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ehsan Natour
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan Willem Sels
- Cardiology Department, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Intensive Care Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Thijs Delnoij
- Cardiology Department, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Intensive Care Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Roberto Lorusso
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
3
|
Wang C, Zhang L, Qin T, Xi Z, Sun L, Wu H, Li D. Extracorporeal membrane oxygenation in trauma patients: a systematic review. World J Emerg Surg 2020; 15:51. [PMID: 32912280 PMCID: PMC7488245 DOI: 10.1186/s13017-020-00331-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has evolved considerably over the past two decades and has been gradually utilized in severe trauma. However, the indications for the use of ECMO in trauma remain uncertain and the clinical outcomes are different. We performed a systematic review to provide an overall estimate of the current performance of ECMO in the treatment of trauma patients. MATERIALS AND METHODS We searched PubMed and MEDLINE databases up to the end of December 2019 for studies on ECMO in trauma. The PRISMA statement was followed. Data on demographics of the patient, mechanism of injury, injury severity scores (ISS), details of ECMO strategies, and clinical outcome were extracted. RESULTS A total of 58 articles (19 retrospective reports and 39 case reports) were deemed eligible and included. In total, 548 patients received ECMO treatment for severe trauma (adult 517; children 31; mean age of adults 34.9 ± 12.3 years). Blunt trauma (85.4%) was the primary injury mechanism, and 128 patients had traumatic brain injury (TBI). The mean ISS was 38.1 ± 15.0. A total of 71.3% of patients were initially treated with VV ECMO, and 24.5% were placed on VA ECMO. The median time on ECMO was 9.6 days, and the median time to ECMO was 5.7 days. A total of 60% of patients received initially heparin anticoagulation. Bleeding (22.9%) and thrombosis (19%) were the most common complications. Ischemia of the lower extremities occurred in 9 patients. The overall hospital mortality was 30.3%. CONCLUSIONS ECMO has been gradually utilized in a lifesaving capacity in severe trauma patients, and the feasibility and advantages of this technique are becoming widely accepted. The safety and effectiveness of ECMO in trauma require further study. Several problems with ECMO in trauma, including the role of VA-ECMO, the time to institute ECMO, and the anticoagulation strategy remain controversial and must be solved in future studies.
Collapse
Affiliation(s)
- Changtian Wang
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China.
| | - Lei Zhang
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Tao Qin
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Zhilong Xi
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Lei Sun
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Haiwei Wu
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Demin Li
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| |
Collapse
|
4
|
Extracorporeal life support in the emergency department: A narrative review for the emergency physician. Resuscitation 2018; 133:108-117. [PMID: 30336233 DOI: 10.1016/j.resuscitation.2018.10.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Extracorporeal life support (ECLS) describes the use of blood perfusion devices to provide advanced cardiac or respiratory support. Advances in percutaneous vascular cannula insertion, centrifugal pump technologies, and the miniaturization of extracorporeal devices have simplified ECLS. The intention of this discussion is to review the role of ECLS as a potential rescue method for emergency department (ED) clinicians in critical clinical scenarios and to focus on the prerequisites for managing an ECLS program in an ED setting. DISCUSSION Possible indications for ECLS cannulation in the ED include ongoing circulatory arrest, shock or refractory hypoxemia and pulmonary embolism with refractory shock. Severe trauma, foreign body obstruction, hypothermia and near drowning are situations in which patients may potentially benefit from ECLS. Early stabilization in the ED can provide a time window for a diagnostic workup and/or urgent procedures, including percutaneous coronary intervention, rewarming or damage control surgery in trauma. The use of ECLS is resource intensive and can be associated with a high risk of complications, especially when performed without previous training. Therefore, ECLS should only be used when the underlying problem is potentially reversible, and the resources are available to address the etiology of organ dysfunction. CONCLUSION Emergent ECLS has a role in the ED for selected indications in the face of life-threatening conditions. ECLS provides a bridge to recovery, definitive therapy, intervention or surgery. ECLS program requires an appropriately trained staff (physicians, nurses and ECLS specialists), equipment resources and logistical planning.
Collapse
|
5
|
Surman TL, Worthington MG, Nadal JM. Cardiopulmonary Bypass in Non-Cardiac Surgery. Heart Lung Circ 2018; 28:959-969. [PMID: 29753653 DOI: 10.1016/j.hlc.2018.04.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/13/2018] [Accepted: 04/07/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) are used to facilitate circulatory support in standard cardiac surgery and emergency intervention, but CPB and ECMO are not used routinely in non-cardiac surgery involving the thorax and major vessels. The primary aim of this study was to identify the type of non-cardiac procedures and bypass used in our institution and review the patient outcomes including perioperative and bypass complications. METHODS A retrospective study was performed within the Royal Adelaide Hospital Cardiothoracic Surgery Unit (CTSU) that examined all operations between 2006 and 2014. There were 1,816 non-cardiac cases, of these nine used CPB or ECMO. Cases excluded from the study were those that required cardiac surgical management with the use of CPB or ECMO. RESULTS Twelve (12) non-cardiac surgery cases were reviewed, with three, and nine cases, respectively, using ECMO and CPB standby or support. The non-cardiac surgical procedures included eight thoracic cases, two renal cases and two tracheal cases. Of the thoracic cases, five were elective, two were bailout and one was an emergency. Both renal cases were bailout (with one as major vessel support and one as standby). Both tracheal cases were bailout (one as an emergency and one as standby). Intraoperative complications included severe haemorrhage in three cases. General postoperative complications included increased analgesia requirement, atelectasis, fever; and prolonged ECMO support and ICU stay which occurred in seven cases. No direct complications of CPB or ECMO are reported. Four of the 12 cases that encompassed thoracic, renal and tracheal surgery are discussed in detail. CONCLUSIONS Our review of 12 cases managed under the CTSU has shown that extracorporeal circulatory support can be used in a range of thoracic, renal and tracheal surgery. These surgical procedures have involved the management of haemodynamically unstable patients. Patient outcomes have been encouraging with few complications. With further research including the use of a larger sample size and control groups, more definitive conclusions could be made on the benefit of CPB and ECMO to patients in non-cardiac surgery.
Collapse
Affiliation(s)
- Timothy Luke Surman
- D'Arcy Sutherland Cardiothoracic Surgery Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
| | | | - Jose Martinelli Nadal
- D'Arcy Sutherland Cardiothoracic Surgery Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| |
Collapse
|
6
|
Perioperative Management of the Adult Patient on Venovenous Extracorporeal Membrane Oxygenation Requiring Noncardiac Surgery. Anesthesiology 2018; 128:181-201. [DOI: 10.1097/aln.0000000000001887] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
The use of venovenous extracorporeal membrane oxygenation is increasing worldwide. These patients often require noncardiac surgery. In the perioperative period, preoperative assessment, patient transport, choice of anesthetic type, drug dosing, patient monitoring, and intraoperative and postoperative management of common patient problems will be impacted. Furthermore, common monitoring techniques will have unique limitations. Importantly, patients on venovenous extracorporeal membrane oxygenation remain subject to hypoxemia, hypercarbia, and acidemia in the perioperative setting despite extracorporeal support. Treatments of these conditions often require both manipulation of extracorporeal membrane oxygenation settings and physiologic interventions. Perioperative management of anticoagulation, as well as thresholds to transfuse blood products, remain highly controversial and must take into account the specific procedure, extracorporeal membrane oxygenation circuit function, and patient comorbidities. We will review the physiologic management of the patient requiring surgery while on venovenous extracorporeal membrane oxygenation.
Collapse
|
7
|
|
8
|
|
9
|
Makdisi G, Makdisi PB, Wang IW. New horizons of non-emergent use of extracorporeal membranous oxygenator support. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:76. [PMID: 27004223 DOI: 10.3978/j.issn.2305-5839.2016.02.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The expansion of the extra corporeal membrane oxygenation (ECMO) use and its indication is strikingly increased in the past few years. ECMO use expanded to lung transplantation, difficult general thoracic resections, transcatheter aortic valve replacement (TAVR) and LVAD implantation. Here we will discuss the indications and the outcomes of non-emergent use of ECMO.
Collapse
Affiliation(s)
- George Makdisi
- 1 Gulf Coast Cardiothoracic Surgery Institute, Tampa General Hospital, Tampa, FL, USA ; 2 Mayo Clinic College of Medicine, Rochester, MN, USA ; 3 Indiana University School of Medicine, Division of Cardiothoracic Surgery, Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
| | - Peter B Makdisi
- 1 Gulf Coast Cardiothoracic Surgery Institute, Tampa General Hospital, Tampa, FL, USA ; 2 Mayo Clinic College of Medicine, Rochester, MN, USA ; 3 Indiana University School of Medicine, Division of Cardiothoracic Surgery, Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
| | - I-Wen Wang
- 1 Gulf Coast Cardiothoracic Surgery Institute, Tampa General Hospital, Tampa, FL, USA ; 2 Mayo Clinic College of Medicine, Rochester, MN, USA ; 3 Indiana University School of Medicine, Division of Cardiothoracic Surgery, Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
| |
Collapse
|
10
|
Rosskopfova P, Perentes JY, Ris HB, Gronchi F, Krueger T, Gonzalez M. Extracorporeal support for pulmonary resection: current indications and results. World J Surg Oncol 2016; 14:25. [PMID: 26837543 PMCID: PMC4736123 DOI: 10.1186/s12957-016-0781-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/26/2016] [Indexed: 12/21/2022] Open
Abstract
Extracorporeal assistances are exponentially used for patients, with acute severe but reversible heart or lung failure, to provide more prolonged support to bridge patients to heart and/or lung transplantation. However, experience of use of extracorporeal assistance for pulmonary resection is limited outside lung transplantation. Airways management with standard mechanical ventilation system may be challenging particularly in case of anatomical reasons (single lung), presence of respiratory failure (ARDS), or complex tracheo-bronchial resection and reconstruction. Based on the growing experience during lung transplantation, more and more surgeons are now using such devices to achieve good oxygenation and hemodynamic support during such challenging cases. We review the different extracorporeal device and attempt to clarify the current practice and indications of extracorporeal support during pulmonary resection.
Collapse
Affiliation(s)
- Petra Rosskopfova
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hans-Beat Ris
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Fabrizio Gronchi
- Division of Thoracic Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thorsten Krueger
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| |
Collapse
|
11
|
Gothner M, Buchwald D, Strauch JT, Schildhauer TA, Swol J. The use of double lumen cannula for veno-venous ECMO in trauma patients with ARDS. Scand J Trauma Resusc Emerg Med 2015; 23:30. [PMID: 25886755 PMCID: PMC4377214 DOI: 10.1186/s13049-015-0106-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 03/04/2015] [Indexed: 12/19/2022] Open
Abstract
Background The use of a double lumen cannula for veno-venous extracorporeal membrane oxygenation (v.v. ECMO) offers several advantages such as cannulation with only one cannula, patient comfort and the earlier mobilization and physiotherapy. The cannulation should be performed under visual wire and cannula placement into the right atrium, which is associated with risks of malposition and right ventricular perforation. The aim of this patient series is to describe the use of double lumen cannula in trauma patients with posttraumatic ARDS. Material and methods Criteria for the v.v ECMO treatment were defined as hypoxaemia (pO2/FiO2 < 200 mmHg, FiO2 0.8-1,0); tidal volume >4-6 ml/kg ideal body weight; mean inspiratory pressure (Pinsp) >32-34 mmHg; respiratory acidosis pH <7.25; and arterial saturation (SaO2) <90%. The analysis included the Injury Severity Score (ISS), the types of injury, time of treatment, complications and outcomes. Results A total of 24 patients with major trauma were treated for posttraumatic ARDS with v.v. ECMO. The double lumen cannula (Avalon®, Fa. Maquet, Rastatt, Germany) was used in six male patients. The mean ISS was 31 (20–48). The ECMO therapy was started in an average on the third day after trauma. The mean ECMO run time was 7 days ± 5 (6–18), and the hospital stay was in mean of 60 days ± 34 (21–105). Conclusion The use of double lumen cannula for v.v ECMO therapy in trauma patients is a feasible treatment option. No higher risk of bleeding could be found in this case series. A PTT-controlled heparinization is recommended using double lumen cannula. Therefore the use of this cannula type in trauma patients with high risk of bleeding is to discuss controversially.
Collapse
Affiliation(s)
- Martin Gothner
- Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| | - Dirk Buchwald
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr-University, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| | - Justus T Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr-University, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| | - Justyna Swol
- Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| |
Collapse
|
12
|
Liu C, Lin Y, Du B, Liu L. Extracorporeal membrane oxygenation as a support for emergency bronchial reconstruction in a traumatic patient with severe hypoxaemia: Figure 1:. Interact Cardiovasc Thorac Surg 2014; 19:699-701. [DOI: 10.1093/icvts/ivu217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
13
|
Venovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure. J Trauma Acute Care Surg 2014; 76:1275-81. [DOI: 10.1097/ta.0000000000000213] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
14
|
Rinieri P, Peillon C, Bessou JP, Veber B, Falcoz PE, Melki J, Baste JM. National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation. Eur J Cardiothorac Surg 2014; 47:87-94. [DOI: 10.1093/ejcts/ezu127] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Muthialu N, Hoskote A, Deshpande R, Lister P. Right pulmonary hilar pedicle injury secondary to blunt chest trauma in a child. Asian Cardiovasc Thorac Ann 2014; 21:235-8. [PMID: 24532632 DOI: 10.1177/0218492312452269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Combined tracheobronchial and thoracic vascular injury in children following blunt trauma to the chest is potentially life-threatening and almost certain to be fatal unless managed promptly. We report one such incident where prompt identification and early aggressive surgical management prevented an almost certain fatal outcome in a 5-year-old girl with complete disruption of the right main bronchus just distal to the carina, and a tear in the right pulmonary artery.
Collapse
Affiliation(s)
- Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | | | | |
Collapse
|
16
|
Ried M, Bein T, Philipp A, Müller T, Graf B, Schmid C, Zonies D, Diez C, Hofmann HS. Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R110. [PMID: 23786965 PMCID: PMC4056791 DOI: 10.1186/cc12782] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 06/20/2013] [Indexed: 12/16/2022]
Abstract
Introduction Severe trauma with concomitant chest injury is frequently associated with acute lung failure (ALF). This report summarizes our experience with extracorporeal lung support (ELS) in thoracic trauma patients treated at the University Medical Center Regensburg. Methods A retrospective, observational analysis of prospectively collected data (Regensburg ECMO Registry database) was performed for all consecutive trauma patients with acute pulmonary failure requiring ELS during a 10-year interval. Results Between April 2002 and April 2012, 52 patients (49 male, three female) with severe thoracic trauma and ALF refractory to conventional therapy required ELS. The mean age was 32 ± 14 years (range, 16 to 72 years). Major traffic accident (73%) was the most common trauma, followed by blast injury (17%), deep fall (8%) and blunt trauma (2%). The mean Injury Severity Score was 58.9 ± 10.5, the mean lung injury score was 3.3 ± 0.6 and the Sequential Organ Failure Assessment score was 10.5 ± 3. Twenty-six patients required pumpless extracorporeal lung assist (PECLA) and 26 patients required veno-venous extracorporeal membrane oxygenation (vv-ECMO) for primary post-traumatic respiratory failure. The mean time to ELS support was 5.2 ± 7.7 days (range, <24 hours to 38 days) and the mean ELS duration was 6.9 ± 3.6 days (range, <24 hours to 19 days). In 24 cases (48%) ELS implantation was performed in an external facility, and cannulation was done percutaneously by Seldinger's technique in 98% of patients. Cannula-related complications occurred in 15% of patients (PECLA, 19% (n = 5); vv-ECMO, 12% (n = 3)). Surgery was performed in 44 patients, with 16 patients under ELS prevention. Eight patients (15%) died during ELS support and three patients (6%) died after ELS weaning. The overall survival rate was 79% compared with the proposed Injury Severity Score-related mortality (59%). Conclusion Pumpless and pump-driven ELS systems are an excellent treatment option in severe thoracic trauma patients with ALF and facilitate survival in an experienced trauma center with an interdisciplinary treatment approach. We encourage the use of vv-ECMO due to reduced complication rates, better oxygenation and best short-term outcome.
Collapse
|
17
|
WETSCH WA, SPÖHR FA, HINKELBEIN J, PADOSCH SA. Emergency extracorporeal membrane oxygenation to treat massive aspiration during anaesthesia induction. A case report. Acta Anaesthesiol Scand 2012; 56:797-800. [PMID: 22571378 DOI: 10.1111/j.1399-6576.2012.02697.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2012] [Indexed: 12/19/2022]
Abstract
Since first described in 1946 by Mendelson, aspiration of gastric content resulting in severe pulmonary complications is a known hazard of general anaesthesia. We report on a case of massive aspiration of gastric content during induction of general anaesthesia, resulting in severe prolonged hypoxaemia with cardiac arrest, followed by rapid onset of an acute respiratory distress syndrome (ARDS) associated with severe global respiratory insufficiency and severe hypoxia. ARDS was successfully treated using emergency extracorporeal membrane oxygenation within 3 h after the incident.
Collapse
Affiliation(s)
- W. A. WETSCH
- Department of Anaesthesiology and Intensive Care Medicine; University Hospital of Cologne; Cologne; Germany
| | - F. A. SPÖHR
- Department of Anaesthesiology and Intensive Care Medicine; University Hospital of Cologne; Cologne; Germany
| | - J. HINKELBEIN
- Department of Anaesthesiology and Intensive Care Medicine; University Hospital of Cologne; Cologne; Germany
| | - S. A. PADOSCH
- Department of Anaesthesiology and Intensive Care Medicine; University Hospital of Cologne; Cologne; Germany
| |
Collapse
|
18
|
Fitzgerald JC, Topjian AA, McInnes AD, Mattei P, McCloskey JJ, Friess SH, Kilbaugh TJ. Bi-caval dual lumen venovenous extracorporeal membrane oxygenation and high-frequency percussive ventilatory support for postintubation tracheal injury and acute respiratory distress syndrome. J Pediatr Surg 2011; 46:e11-5. [PMID: 22152899 DOI: 10.1016/j.jpedsurg.2011.09.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/06/2011] [Accepted: 09/07/2011] [Indexed: 10/14/2022]
Abstract
Bi-caval dual lumen venovenous extracorporeal membrane oxygenation (VV-ECMO) as a nonoperative approach to postintubation tracheal injury has not been described. We report the case of a 7-year-old boy who sustained a postintubation tracheal injury, developed acute respiratory distress syndrome from aspiration and viral pneumonitis, and was supported on bi-caval dual lumen VV-ECMO for 16 days until the trachea healed without surgical repair. Before ECMO decannulation, high-frequency percussive ventilation using a volumetric diffusive respiration ventilator was used for lung recruitment and airway clearance without disruption of the healed trachea. The use of ECMO to allow for lower mean airway pressure during initial healing and high-frequency percussive ventilation for lung recruitment and secretion clearance is a promising strategy to allow nonoperative tracheal injury repair in critically ill patients with multiple comorbidities.
Collapse
Affiliation(s)
- Julie C Fitzgerald
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | |
Collapse
|
19
|
Richter T, Ragaller M. Ventilation in chest trauma. J Emerg Trauma Shock 2011; 4:251-9. [PMID: 21769213 PMCID: PMC3132366 DOI: 10.4103/0974-2700.82215] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 12/09/2010] [Indexed: 12/26/2022] Open
Abstract
Chest trauma is one important factor for total morbidity and mortality in traumatized emergency patients. The complexity of injury in trauma patients makes it challenging to provide an optimal oxygenation while protecting the lung from further ventilator-induced injury to it. On the other hand, lung trauma needs to be treated on an individual basis, depending on the magnitude, location and type of lung or chest injury. Several aspects of ventilatory management in emergency patients are summarized herein and may give the clinician an overview of the treatment possibilities for chest trauma victims.
Collapse
Affiliation(s)
- Torsten Richter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden Carl Gustav Carus, Technical University, Dresden, Germany
| | | |
Collapse
|
20
|
Successful use of extracorporeal life support after double traumatic tracheobronchial injury in a patient with severe acute asthma. Pulm Med 2011; 2011:936240. [PMID: 22135742 PMCID: PMC3206497 DOI: 10.1155/2011/936240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 07/30/2011] [Accepted: 09/20/2011] [Indexed: 11/17/2022] Open
Abstract
We report the case of an asthmatic patient with blunt trachea and left main bronchus injuries who developed acute severe asthma after surgical repair. Despite medical treatment and ventilatory support, asthma persisted with high airway pressures and severe respiratory acidosis. We proposed venovenous extracorporeal life support for CO2 removal which allowed arterial blood gas normalization and airway pressures decrease. Extracorporeal life support was removed on day five after medical treatment of acute severe asthma. So we report the successful use of extracorporeal life support for operated double blunt tracheobronchial injury with acute severe asthma.
Collapse
|
21
|
Berend M, Jahandiez V, Wallet F, Hacquard H, Tronc F, David JS. [Management of tracheobronchial ruptures]. ACTA ACUST UNITED AC 2010; 29:491-3. [PMID: 20558028 DOI: 10.1016/j.annfar.2010.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Accepted: 05/11/2010] [Indexed: 11/19/2022]
Abstract
We report the case of a 25-year-old man who suffered a severe trauma with a complete rupture and separation of the right main bronchus. The patient presented on the scene with respiratory distress and severe hypoxemia. At the admission in the trauma resuscitation unit, the CT scan and fiberoptic examination confirmed the diagnosis of right main bronchus rupture. Selective fiberoptic intubation of the left main bronchus was done and the patient was sent to the operating theater for urgent thoracotomy. During thoracotomy, profound arterial oxygen desaturation requested the right main bronchus being intubated by the surgeon under the control of view and separate lung ventilation, until the end of the bronchus suture. Surgery allowed the patient to survive. He was then discharged alive from the hospital at day 36. Severe tracheobronchial rupture may be rapidly associated with major respiratory distress and severe hypoxemia that necessitate specialised care in referring centre. Initial orientation of these patients appears to be as important that airway and hypoxemia management.
Collapse
Affiliation(s)
- M Berend
- Département d'anesthésie-réanimation-urgences, centre hospitalier Lyon-Sud, Hospices civils de Lyon, Pierre-Bénite, France
| | | | | | | | | | | |
Collapse
|
22
|
Treatment of endobronchial hemorrhage after blunt chest trauma with extracorporeal membrane oxygenation (ECMO). ACTA ACUST UNITED AC 2008; 65:1151-4. [PMID: 19001989 DOI: 10.1097/01.ta.0000235492.09223.83] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
23
|
Setty SP, Linden BC, Herrington C, McGonigal M. Pediatric tracheal disruption repaired via median sternotomy. THE JOURNAL OF TRAUMA 2008; 64:493-5. [PMID: 16983302 DOI: 10.1097/01.ta.0000222640.52306.4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Shaun P Setty
- Division of Cardiovascular and Thoracic Surgery, University of Minnesota, USA
| | | | | | | |
Collapse
|
24
|
Abstract
Flail chest is an uncommon consequence of blunt trauma. It usually occurs in the setting of a high-speed motor vehicle crash and can carry a high morbidity and mortality. The outcome of flail chest injury is a function of associated injuries. Isolated flail chest may be successfully managed with aggressive pulmonary toilet including facemask oxygen, CPAP, and chest physiotherapy. Adequate analgesia is of paramount importance in patient recovery and may contribute to the return of normal respiratory mechanics. Early intubation and mechanical ventilation is paramount in patients with refractory respiratory failure or other serious traumatic injuries. Prolonged mechanical ventilation is associated with the development of pneumonia and a poor outcome. Tracheotomy and frequent flexible bronchoscopy should be considered to provide effective pulmonary toilet. Surgical stabilization is associated with a faster ventilator wean, shorter ICU time, less hospital cost, and recovery of pulmonary function in a select group of patients with flail chest. Open fixation is appropriate in patients who are unable to be weaned from the ventilator secondary to the mechanics of flail chest. Persistent pain, severe chest wall instability, and a progressive decline in pulmonary function testing in a patient with flail chest are also indications for surgical stabilization. Open fixation is also indicated for flail chest when thoracotomy is performed for other concomitant injuries. There is no role for surgical stabilization for patients with severe pulmonary contusion. The underlying lung injury and respiratory failure preclude early ventilator weaning. Supportive therapy and pneumatic stabilization is the recommended approach for this patient subset.
Collapse
Affiliation(s)
- Brian L Pettiford
- Heart, Lung and Esophlageal Surgery Institute, University of Pittsburgh Medical Center, Shadyside Medical Center, Pittsburgh, PA 15232, USA
| | | | | |
Collapse
|
25
|
Ruttmann E, Weissenbacher A, Ulmer H, Müller L, Höfer D, Kilo J, Rabl W, Schwarz B, Laufer G, Antretter H, Mair P. Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. J Thorac Cardiovasc Surg 2007; 134:594-600. [PMID: 17723804 DOI: 10.1016/j.jtcvs.2007.03.049] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Revised: 03/12/2007] [Accepted: 03/22/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Extracorporeal circulation is considered the gold standard in the treatment of hypothermic cardiocirculatory arrest; however, few centers use extracorporeal membrane oxygenation instead of standard extracorporeal circulation for this indication. The aim of this study was to evaluate whether extracorporeal membrane oxygenation-assisted resuscitation improves survival in patients with hypothermic cardiac arrest. METHODS A consecutive series of 59 patients with accidental hypothermia in cardiocirculatory arrest between 1987 and 2006 were included. Thirty-four patients (57.6%) were resuscitated by standard extracorporeal circulation, and 25 patients (42.4%) were resuscitated by extracorporeal membrane oxygenation. Accidental hypothermia was caused by avalanche in 22 patients (37.3%), drowning in 22 patients (37.3%), exposure to cold in 8 patients (13.5%), and falling into a crevasse in 7 patients (11.9%). Multivariate logistic regression analysis was used to compare extracorporeal membrane oxygenation with extracorporeal circulation resuscitation, with adjustment for relevant parameters. RESULTS Restoration of spontaneous circulation was achieved in 32 patients (54.2%). A total of 12 patients (20.3%) survived hypothermia. In the extracorporeal circulation group, 64% of the nonsurviving patients who underwent restoration of spontaneous circulation died of severe pulmonary edema, but none died in the extracorporeal membrane oxygenation group. In multivariate analysis, extracorporeal membrane oxygenation-assisted resuscitation showed a 6.6-fold higher chance for survival (relative risk: 6.6, 95% confidence interval: 1.2-49.3, P = .042). Asphyxia-related hypothermia (avalanche or drowning) was the most predictive adverse factor for survival (relative risk: 0.09, 95% confidence interval: 0.01-0.60, P = .013). Potassium and pH failed to show statistical significance in the multivariate analysis. CONCLUSIONS Extracorporeal rewarming with an extracorporeal membrane oxygenation system allows prolonged cardiorespiratory support after initial resuscitation. Our data indicate that prolonged extracorporeal membrane oxygenation support reduces the risk of intractable cardiorespiratory failure commonly observed after rewarming.
Collapse
Affiliation(s)
- Elfriede Ruttmann
- Department of Cardiac Surgery, Innsbruck Medical University, Tyrol, Austria.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Rico FR, Cheng JD, Gestring ML, Piotrowski ES. Mechanical ventilation strategies in massive chest trauma. Crit Care Clin 2007; 23:299-315, xi. [PMID: 17368173 DOI: 10.1016/j.ccc.2006.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients in extremis because of trauma-related massive chest injury require expedient evaluation and prompt intervention. The initial pathophysiology relates to the significant intrapulmonary shunting caused by disruption of pulmonary capillaries and extravasation into the alveolar spaces. Disproportionate or unilateral lung involvement needs measures more technical than general supportive care. Independent lung ventilation (mostly with unilateral lung involvement) and other strategies like inhaled nitric oxide, prone positioning, partial liquid ventilation, and extracorporeal membrane oxygenation (ECMO) have had good results. Intensivists confronted with this clinical subset may consider using these strategies as alternative/adjunctive options for optimizing respiratory and hemodynamic status in the supportive management of trauma-related acute lung injury (ALI) and adult respiratory distress syndrome (ARDS).
Collapse
Affiliation(s)
- Ferdinand R Rico
- Division of Trauma and Critical Care, University of Rochester Medical Center, Strong Memorial Hospital, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA.
| | | | | | | |
Collapse
|
27
|
Jotoku H, Sugimoto S, Usui A, Tanaka A, Makise H. Venovenous extracorporeal membrane oxygenation as an adjunct to surgery for empyema: report of a case. Surg Today 2006; 36:76-8. [PMID: 16378199 DOI: 10.1007/s00595-005-3099-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Accepted: 05/24/2005] [Indexed: 11/26/2022]
Abstract
Empyema is a serious and often life-threatening condition. We report the case of a 45-year-old man with severe hypoxia caused by empyema after streptococcal pneumonia, which we successfully treated by surgical drainage assisted by a venovenous extracorporeal membrane oxygenation (ECMO) device. This device provided sufficient oxygenation during the perioperative period and was not associated with excessive bleeding under systemic heparinization. This case report shows the effectiveness of ECMO in allowing surgery and enhancing its benefits in patients with serious hypoxia.
Collapse
Affiliation(s)
- Hiromi Jotoku
- Department of Emergency and Critical Care Medicine, Sapporo City General Hospital, North-11 West-13, Chuo-ku, Sapporo 060-8604, Japan
| | | | | | | | | |
Collapse
|
28
|
Sobottke R, Friese J, Ozokyay L, Muhr G, Wick M. [Polytrauma with severe lung contusion. Early use of extracorporeal membrane oxygenation]. Unfallchirurg 2006; 109:805-8. [PMID: 16924442 DOI: 10.1007/s00113-006-1117-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a technique for sustaining body oxygenation in case of respiratory failure. Since ECMO technology has undergone improvements resulting in better hemo-compatibility and reduced side effects, venovenous ECMO is a mostly accepted treatment of adult respiratory distress syndrome (ARDS). One should discuss the early initiation of ECMO therapy for post-traumatic respiratory failure. We report about a 23-year-old male and a 15-year-old female patient, who suffered polytrauma and received early treatment with ECMO because of severe lung contusion.
Collapse
Affiliation(s)
- R Sobottke
- Klinik und Poliklinik für Orthopädie der Universität zu Köln, 50924 Köln, Deutschland.
| | | | | | | | | |
Collapse
|
29
|
Cordell-Smith JA, Roberts N, Peek GJ, Firmin RK. Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO). Injury 2006; 37:29-32. [PMID: 16243331 DOI: 10.1016/j.injury.2005.03.027] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Revised: 03/24/2005] [Accepted: 03/24/2005] [Indexed: 02/02/2023]
Abstract
BACKGROUND Conventional mechanical ventilation is the mainstay of treatment for severe respiratory failure associated with trauma. However, when extensive lung injury is present, this technique may not be sufficient to prevent hypoxia, and furthermore, may exacerbate pulmonary damage by barotrauma. Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill adult trauma patients and can offer an additional treatment modality. This study reports the use of ECMO in a cohort of adults referred with severe respiratory failure following trauma. METHODS Retrospective analysis over an 8-year period of all 28 adult patients referred to a single tertiary unit for ECMO support. Survival relative to Injury severity score (ISS), lung injury score (Murray grade), duration of treatment and patient age was evaluated. RESULTS Twenty of 28 patients who received ECMO with severe trauma related respiratory failure (mean PaO2/FiO2 of 62 mmHg) survived. Most patients had long bone fractures, blunt chest trauma, or combined injuries. Lung injury and injury severity scores, patient age, ECMO duration and oxygenation indices pre-ECMO (PaO2/FiO2) were similar in both the survivor and non-survivor groups. CONCLUSION A high proportion of trauma patients treated with ECMO for severe lung injury survived. This outcome appears to compare favourably to conventional ventilation techniques and may have a role in patients who develop acute severe respiratory distress associated with trauma.
Collapse
Affiliation(s)
- J A Cordell-Smith
- Heartlink ECMO Centre, The Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. mailto:
| | | | | | | |
Collapse
|
30
|
Friesenecker BE, Peer R, Rieder J, Lirk P, Knotzer H, Hasibeder WR, Mayr AJ, Dünser MW. Craniotomy during ECMO in a severely traumatized patient. Acta Neurochir (Wien) 2005; 147:993-6; discussion 996. [PMID: 16021388 DOI: 10.1007/s00701-005-0568-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 05/24/2005] [Indexed: 11/24/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) can be a last resort treatment in acute respiratory distress syndrome after thoracic trauma. However, co-existent brain trauma is considered to be a contra-indication for ECMO. This is the first report on successful craniotomy under ECMO treatment in a multiply traumatized patient with severe thoracic and brain injuries. This successful treatment with beneficial neurological outcome suggests that ECMO therapy should not be withheld from severely injured patients with combined brain and thoracic trauma presenting with life-threatening hypoxemia. Moreover, even craniotomy may be performed during ECMO therapy without major bleeding and adverse effects on neurological function.
Collapse
Affiliation(s)
- B E Friesenecker
- Department of Anaesthesiology and Critical Care Medicine, Division of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
An estimated 16 million Americans are afflicted with some degree of chronic obstructive pulmonary disease (COPD), accounting for 100,000 deaths per year. The only current treatment for chronic irreversible pulmonary failure is lung transplantation. Since the widespread success of single and double lung transplantation in the early 1990s, demand for donor lungs has steadily outgrown the supply. Unlike dialysis, which functions as a bridge to renal transplantation, or a ventricular assist device (VAD), which serves as a bridge to cardiac transplantation, no suitable bridge to lung transplantation exists. The current methods for supporting patients with lung disease, however, are not adequate or efficient enough to act as a bridge to transplantation. Although occasionally successful as a bridge to transplant, ECMO requires multiple transfusions and is complex, labor-intensive, time-limited, costly, non-ambulatory and prone to infection. Intravenacaval devices, such as the intravascular oxygenator (IVOX) and the intravenous membrane oxygenator (IMO), are surface area limited and currently provide inadequate gas exchange to function as a bridge-to-recovery or transplant. A successful artificial lung could realize a substantial clinical impact as a bridge to lung transplantation, a support device immediately post-lung transplant, and as rescue and/or supplement to mechanical ventilation during the treatment of severe respiratory failure.
Collapse
|
32
|
Alpard SK, Zwischenberger JB. Extracorporeal membrane oxygenation for severe respiratory failure. CHEST SURGERY CLINICS OF NORTH AMERICA 2002; 12:355-78, vii. [PMID: 12122829 DOI: 10.1016/s1052-3359(02)00002-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The use of extracorporeal technology to accomplish gas exchange with or without cardiac support is based on the premise that "lung rest" facilitates repair and avoids the baso- or volutrauma of mechanical ventilator management. Extracorporeal membrane oxygenation (ECMO), a modified form of cardiopulmonary bypass, has been shown to decrease mortality of neonatal, pediatric and adult respiratory failure and is capable of total gas exchange. In neonates, over 20,638 patients have been treated with an overall survival of 77% in a population thought to have 78% mortality.
Collapse
Affiliation(s)
- Scott K Alpard
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | | |
Collapse
|
33
|
|
34
|
Chughtai T, Hazan C, Tahta S, Shum-Tim D, Fleiszer D, Evans D, Brown R, Mulder D. Successful use of extracorporeal life support in two cases of posttraumatic adult respiratory distress syndrome. THE JOURNAL OF TRAUMA 2001; 50:1137-9. [PMID: 11426130 DOI: 10.1097/00005373-200106000-00025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Chughtai
- Department of Surgery, Division of Cardiothoracic Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada
| | | | | | | | | | | | | | | |
Collapse
|
35
|
|