Early veno-venous extracorporeal membrane oxygenation is an effective strategy for traumatically injured patients presenting with refractory respiratory failure

Powell, Eleanor A.; Reynolds, Tyler; Webb, Judith A. W.; Kundi, Rishi; Cantú, José Antonio Infante; Keville, Meaghan P.; O’Connor, James V.; Stein, Deborah M.; Hanson, Melissa; Taylor, Bradley S.; Scalea, Thomas M.; Galvagno, Samuel M.

doi:10.1097/ta.0000000000004057

Cited by 3 publications

(1 citation statement)

References 47 publications

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“…65 A recent single-center retrospective cohort study of early VV-ECMO to stabilize patients to undergo procedural treatment of injuries reported a 70% survival in 57 patients. 66 Optimal ventilation while on ECMO remains a topic of great interest. Benefits of continuing mechanical ventilation on ECMO versus extubation and complete liberation from the ventilator are unknown.…”

Section: Nonventilator Adjuncts In Ards and Severe Hypoxemiamentioning

confidence: 99%

Modern mechanical ventilation strategies for the acute care surgeon: What you need to know

Park,

Napolitano

2024

J Trauma Acute Care Surg

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Acute respiratory failure (ARF) is associated with significant morbidity and mortality in trauma and emergency surgery patients. Pulmonary complications following surgery among the most frequent and costly postoperative events. ARF support with mechanical ventilation is life-saving but may lead to ventilator-induced lung injury (VILI), worsening secondary injury. Decades of randomized clinical trials have demonstrated that evidence-based ventilator management can improve outcomes, but one-size-fits-all mechanical ventilation protocols fail to achieve true individualized, personalized care for ARF. This review presents the current evidence for mechanical ventilation support strategies for ARF including lung protective ventilation, judicious target setting, conservative fluid management appropriate light sedation, strategies to prevent ventilator-associated pneumonia and early attempts at ventilator weaning and extubation to be deployed to optimized patient outcomes. Specific mechanical ventilation strategies for patients with traumatic brain injury, obesity and acute respiratory distress syndrome will also be reviewed.

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Section: Nonventilator Adjuncts In Ards and Severe Hypoxemiamentioning

confidence: 99%

Modern mechanical ventilation strategies for the acute care surgeon: What you need to know

Park,

Napolitano

2024

J Trauma Acute Care Surg

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Anticoagulation Can Be Held in Traumatically Injured Patients on Veno-Venous Extracorporeal Membrane Oxygenation Support

Niles,

Kundi,

Scalea

et al. 2024

ASAIO Journal

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Traumatic injury is associated with several pulmonary complications, including pulmonary contusion, transfusion-related acute lung injury (TRALI), and the development of acute respiratory distress syndrome (ARDS). There is a lack of literature on these patients supported with veno-venous extracorporeal oxygenation (VV ECMO). Understanding the safety of using VV ECMO to support trauma patients and the ability to hold anticoagulation is important to broaden utilization. This is a single-center retrospective cohort study of adult trauma patients cannulated for VV ECMO during their initial admission over an 8 year period (2014–2021). We hypothesize that anticoagulation can be held in trauma patients on VV ECMO without increasing mortality or prothrombotic complications. We also describe the coagulopathy of traumatically injured patients on VV ECMO. Withholding anticoagulation was not associated with mortality in our study population, and there were no significant differences in bleeding or clotting complications between patients who did and did not receive systemic anticoagulation. Patients in the nonsurvivor group had increased coagulopathy both pre- and post-cannulation. Our study suggests anticoagulation can be safely withheld in traumatically injured VV ECMO patients without increasing mortality, complication rates, or transfusion requirements. Future, multicenter prospective studies with larger sample sizes are required to confirm our results.

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Novel Non-surgical Strategy of Severe Chest Trauma With Venovenous Extracorporeal Membrane Oxygenation, Angioembolization, and Bronchial Blocker: A Case Report

Morito,

Matsumura

2024

Cureus

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Severe chest trauma often requires immediate intervention, typically involving open chest surgery. However, advancements in medical technology offer alternative approaches, such as endovascular therapy and venovenous extracorporeal membrane oxygenation (VV-ECMO). In a recent case, a middle-aged male cyclist was admitted after colliding with a vehicle, presenting in shock with multiple injuries, including cerebral contusion and rib fractures. Despite initial treatments such as chest tubes and blood transfusions, his condition remained unstable, with worsening respiratory failure and hemorrhagic shock. A multidisciplinary team devised a comprehensive treatment plan, utilizing VV-ECMO for oxygenation support, a bronchial blocker to localize the hematoma, and interventional radiology for hemothorax hemostasis. These interventions successfully stabilized the patient without resorting to open chest surgery. Endovascular therapy, alongside bronchial blockers, facilitated adequate hemostasis and hematoma localization, avoiding invasive procedures. VV-ECMO plays a crucial role in maintaining oxygenation during respiratory failure. Strategic anticoagulation with nafamostat mesylate prevented clotting in the ECMO circuit. This case highlights the effectiveness of minimally invasive strategies in managing severe chest trauma, preserving lung function, and improving outcomes. In refractory cases, VV-ECMO acts as a bridge to stabilize respiratory status before definitive treatment, while bronchial blockers localize hematomas, reducing the need for surgery. Interventional radiology offers a less invasive option for achieving hemostasis. Collaboration among medical specialties and innovative technologies is critical to successfully navigating complex chest trauma cases.

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Early veno-venous extracorporeal membrane oxygenation is an effective strategy for traumatically injured patients presenting with refractory respiratory failure

Cited by 3 publications

References 47 publications

Modern mechanical ventilation strategies for the acute care surgeon: What you need to know

Modern mechanical ventilation strategies for the acute care surgeon: What you need to know

Anticoagulation Can Be Held in Traumatically Injured Patients on Veno-Venous Extracorporeal Membrane Oxygenation Support

Novel Non-surgical Strategy of Severe Chest Trauma With Venovenous Extracorporeal Membrane Oxygenation, Angioembolization, and Bronchial Blocker: A Case Report

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