Clinical outcomes of extracorporeal membrane oxygenation in acute traumatic lung injury: a retrospective study

Lee, Hong Kyu; Kim, Hyoung Soo; Ha, Sang Ook; Park, Sunghoon; Lee, Hee Sung; Lee, Soo Kyung; Lee, Sun Hee

doi:10.1186/s13049-020-00733-w

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…TBI was previously contraindicated for ECMO due to the heightened risk of intracranial hemorrhage from systemic anticoagulation [ 30 , 60 , 61 ]. Recently, advancements in procedures have mitigated this bleeding risk, including low-dose anticoagulation [ 29 , 33 ], delayed anticoagulation (after 48–72 h) [ 9 , 37 ], heparin-free application [ 36 , 41 ], and improved heparin-binding circuits [ 21 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

ECMO in adult patients with severe trauma: a systematic review and meta-analysis

Zhang,

Huang

et al. 2023

Eur J Med Res

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Background Severe trauma can result in cardiorespiratory failure, and when conventional treatment is ineffective, extracorporeal membrane oxygenation (ECMO) can serve as an adjunctive therapy. However, the indications for ECMO in trauma cases are uncertain and clinical outcomes are variable. This study sought to describe the prognosis of adult trauma patients requiring ECMO, aiming to inform clinical decision-making and future research. Methods A comprehensive search was conducted on Pubmed, Embase, Cochrane, and Scopus databases until March 13, 2023, encompassing relevant studies involving over 5 trauma patients (aged ≥ 16 years) requiring ECMO support. The primary outcome measure was survival until discharge, with secondary measures including length of stay in the ICU and hospital, ECMO duration, and complications during ECMO. Random-effects meta-analyses were conducted to analyze these outcomes. The study quality was assessed using the Joanna Briggs Institute checklist, while the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results The meta-analysis comprised 36 observational studies encompassing 1822 patients. The pooled survival rate was 65.9% (95% CI 61.3–70.5%). Specifically, studies focusing on traumatic brain injury (TBI) (16 studies, 383 patients) reported a survival rate of 66.1% (95% CI 55.4–76.2%), while studies non-TBI (15 studies, 262 patients) reported a survival rate of 68.1% (95% CI 56.9–78.5%). No significant difference was observed between these two survival comparisons (p = 0.623). Notably, studies utilizing venoarterial extracorporeal membrane oxygenation (VA ECMO) (15 studies, 39.0%, 95% CI 23.3–55.6%) demonstrated significantly lower survival rates than those using venovenous extracorporeal membrane oxygenation (VV ECMO) (23 studies, 72.3%, 95% CI 63.2–80.7%, p < 0.001). The graded assessment of evidence provided a high degree of certainty regarding the pooled survival. Conclusions ECMO is now considered beneficial for severely traumatized patients, improving prognosis and serving as a valuable tool in managing trauma-related severe cardiorespiratory failure, haemorrhagic shock, and cardiac arrest.

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Section: Discussionmentioning

confidence: 99%

ECMO in adult patients with severe trauma: a systematic review and meta-analysis

Zhang,

Huang

et al. 2023

Eur J Med Res

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“…In fact, in the past few decades, VV ECMO has been used worldwide to maintain treatment for patients with intractable respiratory failure. 9 With the emergence of VV ECMO, we can use lower tidal volume and airway pressure to achieve lung protection and improve oxygenation and lung recovery, which can makes it possible to wean patients from mechanical ventilator support. In this case, the patient developed spinal cord injury after trauma and secondary infection of drug-resistant bacteria in the lung.…”

Section: Discussionmentioning

confidence: 99%

Heparin-free adventitia pulmonary oxygenation in the treatment of trauma complicated with severe pulmonary infection: a case report

Zeng

Yang

et al. 2021

Perfusion

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The application of Venovenous (VV) extracorporeal membrane oxygenation (ECMO) in trauma and patients with severe bleeding tendency has been controversial. However, VV ECMO without anticoagulation contributes to reducing the risk of bleeding during ECMO maintenance. VV ECMO serves critical roles in therapy of patients with severe pulmonary infection and failure in conventional therapy. The common peripheral catheterization approach for VV ECMO is femoral vein-internal jugular vein catheterization, and bilateral femoral vein catheterization can also achieve the purpose of respiratory support for patients with limited cervical catheterization. In this case report, we described a patient with post-traumatic cervical spinal cord injury and severe pulmonary infection who was successfully treated with heparin-free intravenous ECMO.

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“…Results of ECLS use in chest trauma patients have been reported as positive by several small studies (39)(40)(41). Guirand et al demonstrated that V-V ECMO was even associated with higher survival compared to conventional mechanical ventilation (41), mirroring the results of much larger studies performed in ARDS patients (42)(43)(44)(45).…”

Section: Chest Trauma and Parenchymal Injurymentioning

confidence: 95%

Extracorporeal life support in thoracic emergencies—a narrative review of current evidence

Willers¹,

Mariani²,

Maessen³

et al. 2023

J Thorac Dis

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Background and Objective: Resuscitative therapies for respiratory and cardiac failure are lifesaving and extended by using extracorporeal life support (ECLS) as mechanical circulatory support (MSC). This review informs the debate to identify the life-threatening thoracic emergencies in which patients may be cannulated for ECLS support.Methods: An advanced search was performed in PubMed, Embase, Google Scholar, and references query, assessed in June 2022, identified 761 records. Among them, 74 publications in English were included in the current narrative review.Key Content and Findings: ECLS is an additional tool for organ support in life-threatening thoracic emergencies. It provides bridging to recovery or to decision about destination as definitive therapy, intervention, or surgery. Non-traumatic emergencies include mediastinal mass, acute lung injury (ALI), aspiration, embolisms, acute and chronic heart failure. However, based on the current evidence, trauma, and especially blunt thoracic trauma, is one of the main indications for ECLS use in thoracic emergencies, among others in chest wall fractures, blunt and penetrating lung injuries. ECLS use is always individualized to patient's needs, injury pattern and kind of organ failure, circulatory arrest inclusive, depending on if respiratory or cardiac and circulatory support is needed. Further, ECLS offers the possibility for fast volume resuscitation and rewarming, thus preventing the lethal of trauma: hypothermia, hypoperfusion and acidosis. Anticoagulation may be omitted for some hours or days. Interdisciplinary cooperation between the intensivists, surgeons, anesthesiologists, emergency medical services, an appropriately organized and trained staff, equipment resources and logistical planning are essential for successful outcomes.Conclusions: ECLS use in selected life-threatening thoracic emergencies is increasing. The summarized findings appeal to policymakers, and we hope that our summary of recommendations may impact clinical practice and research.

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Clinical outcomes of extracorporeal membrane oxygenation in acute traumatic lung injury: a retrospective study

Cited by 10 publications

References 21 publications

ECMO in adult patients with severe trauma: a systematic review and meta-analysis

ECMO in adult patients with severe trauma: a systematic review and meta-analysis

Heparin-free adventitia pulmonary oxygenation in the treatment of trauma complicated with severe pulmonary infection: a case report

Extracorporeal life support in thoracic emergencies—a narrative review of current evidence

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