Craniotomy during ECMO in a severely traumatized patient

Friesenecker, Barbara; Peer, R.; Rieder, Josef; Lirk, Philipp; Knotzer, Hans; Hasibeder, Walter; Mayr, A; Dünser, Martin W.

doi:10.1007/s00701-005-0568-5

Cited by 35 publications

(19 citation statements)

References 11 publications

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“…However, ECMO is still a controversy on a multitrauma combining pulmonary failure and blunt abdominal trauma needing only nonoperative management. Of the total 11 cases reported in detail in the literature (Table 2), six patients had concurrent BAT with liver or spleen laceration [2,4,8,9]. Only one received successful nonoperative treatment for grade III liver laceration [4].…”

Section: Discussionmentioning

confidence: 99%

“… Combined injury besides pulmonary failure Intervention ECMO Heparin ECMO duration Outcome Madershahian et al [2]1, 19/FSpleen, LiverLaparotomyv-a 5 (+)138 hoursSurvivedRight main bronchusThoracotomy2, 48/MVertebra and long bone FractureOsteosynthesisv-a(+)120 hoursSurvived3, 26/MSpleenSplenectomyv-va 6 (+)84 hoursSurvivedBrainYuan et al [5]4, 18/MLiver, Gr. IIIConservativev-v(+)10 daysSurvivedEndobronchial hemorrhage5, 38/MBrain SDH 1 Conservativev-v(+)5 daysSurvivedCampione et al [4]6, 14/MBronchial DisruptionRight bilobectomy of lungv-v(+)3 daysSurvivedYen et al [7]7, 21/MBrain EDH 2 Decompressive craniotomyv-a(+)49 hoursSurvivedFriesenecker, et al [8]8, 34/MLiver, SpleenLaparotomyv-v(+)17 daysSurvivedBrain ICH 3 with edemaDecompressive craniotomyMuellenbach et al [9]9, 53/MLiverLaparotomyv-v(−)8 daysSurvivedTraumatic brain injuryICP 4 Monitoring10, 16/MTraumatic brain injuryv-v(−)3 daysSurvived11, 28/MSpleenSplenectomyv-v(−)2 daysSurvivedTraumatic brain injury...…”

Section: Literature Reviewmentioning

confidence: 99%

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Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review

et al. 2015

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Pulmonary contusion and acute respiratory distress syndrome (ARDS) is a common manifestation in polytraumatic patients. Although mechanical ventilation is still the first choice of treatment, a group of patients are still unable to maintain their oxygenation. The role of extracorporeal membrane oxygenation (ECMO) has been more clarified when the lung is extensively damaged and when conventional modality failed. ECMO provides the lung an opportunity to rest by permitting reduced ventilator settings and limiting further barotraumas. However, ECMO is still considered contraindicated in polytramatic patients combining pulmonary contusion and other organ hemorrhage because of systemic anticoagulation during the treatment. We herein report a patient who successfully survive a multitrauma combining pulmonary contusion and grade IV liver laceration using non-heparinized venovenous extracorporeal membrane oxygenation (vv-ECMO). The associated literature were reviewed.

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Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review

et al. 2015

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“…23 Friesenecker et al performed a decompressive craniectomy and evacuation of an intracerebral hemorrhage under ECMO in a young polytrauma patient with adult respiratory distress syndrome after thoracic trauma. 13 Hwang et al safely used ECMO in a patient with neurogenic pulmonary edema who underwent successful clipping for a ruptured anterior communicating artery aneurysm. 19 A major concern with ECMO therapy is the increased risk of intracranial hemorrhage from anticoagulation, especially in the setting of a craniotomy.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report

Choudhri

Shah

Basarab-Tung

et al. 2015

JNS

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C ardiopulmonary bypass using the heart-lung machine was initiated in 1937 by Gibbons and subsequently has been used for open cardiac surgery since 1954. 15 However, given the limitations of membrane oxygenation, it could not be used for long durations. 41 This gave way to the development of extracorporeal membrane oxygenation (ECMO) in 1972 by Hill et al. 18,31 ECMO is a last-resort intensive care technique indicated during cardiopulmonary failure due to potentially reversible causes. ECMO provides circulatory support by assuming the role of the heart and lungs to maintain blood flow and oxygenation to the vital organs, including the brain.14 Most data on the success of ECMO come from its primary indication for respiratory failure in newborns. Four prospective randomized controlled trials in newborns and one in adults have shown a significant survival advantage with ECMO for severe respiratory distress. 11,29 The data and indications for ECMO in the setting of cardiac failure are still evolving. Conventional extracorporeal circuits are routinely used in elective cardiac surgery where the right atrium and aorta are directly cannulated to allow unobstructed flow. 15Although ECMO is derived from cardiopulmonary bypass, differences between them include minimal heparin use, peripheral cannulation, lack of a cardiotomy reservoir, and no autotransfusion. Since these early developments, ECMO has transiabbreviatioNs CPR = cardiopulmonary resuscitation; EC-IC = extracranial-to-intracranial; ECMO = extracorporeal membrane oxygenation; ECPR = extracorporeal CPR; MMD = moyamoya disease; VA = venoarterial; VV = veno-venous. The authors describe the case of a 51-year-old man with bilateral moyamoya disease and prior strokes who developed an asystolic cardiac arrest while undergoing revascularization surgery under mild hypothermia. The patient was successfully treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) after manual cardiopulmonary resuscitation (CPR) was unsuccessful for 45 minutes. ECMO is a cardiopulmonary support system that is indicated for respiratory failure in pediatric and adult patients. It is increasingly being used as an extension to mechanical CPR for patients who have suffered cardiac arrest if the underlying cause of cardiac arrest is thought to be reversible. Identifying which patients should be placed on emergency ECMO after cardiac arrest is controversial given its high morbidity and mortality. ECMO in neurosurgical settings has associated risks of intracranial hemorrhage and neurological compromise, while resource utilization is paramount given the high costs of this treatment. This paper is significant because it describes the use of ECMO in an unindicated setting. Limited data are available for ECMO usage after cardiac arrest with baseline cerebral ischemia. Furthermore, this paper raises important considerations for extracorporeal CPR use in a patient who had recently undergone craniotomy. The patient in this report remained on ECMO for 48 hours, after which he was successfu...

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“…However, it is of note that 22 patients in the ECMO group did not receive ECMO because they improved without it, and that it took 5 years to recruit 180 patients. There are case reports of ECMO being used in patients with TBI who have undergone concurrent [69] and recent [70] craniotomy, with subsequent good neurological outcome. In the latter of these case reports, the patient did not undergo systemic heparinization at institution of ECMO, and heparin-bonded circuitry was utilized.…”

Section: Extracorporeal Membrane Oxygenationmentioning

confidence: 96%

Ventilatory strategies for patients with acute brain injury

Young

Rhodes

Mascia

et al. 2010

Current Opinion in Critical Care

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There are unlikely to be randomized controlled trials advising how best to ventilate patients with acute brain injuries because of the heterogeneous nature of such injuries. Hypoxia should be avoided. The more widespread use of multimodal brain monitoring, including brain tissue oxygen and cerebral blood flow monitoring, may allow clinicians to tolerate a higher arterial partial pressure of carbon dioxide than has been traditional, allowing a less injurious ventilatory strategy. Modest positive end-expiratory pressure can be used. In severe respiratory failure, most 'rescue' strategies have been attempted in patients with acute brain injuries. Choice of rescue therapy at present is best decided on a case-by-case basis in conjunction with local expertise.

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Craniotomy during ECMO in a severely traumatized patient

Cited by 35 publications

References 11 publications

Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review

Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review

Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report

Ventilatory strategies for patients with acute brain injury

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