Extracorporeal membrane oxygenation in respiratory failure for pulmonary contusion and bronchial disruption after trauma

Abstract

xtracorporeal membrane oxygenation (ECMO) may offer lifesaving treatment in severe pulmonary contusion or acute respiratory distress syndrome when conventional treatments have failed. 1,2 Although ECMO has become the standard treatment for neonatal severe respiratory failure, interest in adult ECMO weakened because of the high mortality until investigators 3 began dictating that it should be used in children and in adult respiratory failure.Use in trauma is restricted 4,5 because of the risk of systemic anticoagulation in patients with multiple trauma.

Reconstrucción traqueal bajo oxigenación con membrana para circulación extracorpórea para el manejo de una lesión traumática: reporte de caso y revisión bibliográfica

“…Esto abre una puerta para el tratamiento de este tipo de pacientes, ya que permite disminuir al máximo la presión utilizada en la asistencia respiratoria mecánica sin comprometer la oxigenación tisular y, además, usar asistencia respiratoria espontánea, disminuyendo la sedación al máximo, lo que conlleva un despertar temprano del paciente y una mejoría clínica más rápida 17,18 . Hasta la fecha, se ha utilizado en el periodo perioperatorio en casos de trasplante pulmonar 19 , trauma traqueo-bronquial [20][21][22][23] , lesiones iatrogé-nicas durante procedimientos oncológicos 24 y trastornos congénitos de la vía respiratoria 25,26 ; en todos, ha demostrado ser una herramienta de salvamento útil cuando el deterioro pulmonar es grave y no mejora con asistencia respiratoria.…”

Outcomes of Extracorporeal Life Support in Trauma

“…With respect to blunt and penetrating thoracic trauma, venoarterial (VA) ECLS has been successfully used in managing postoperative cardiopulmonary failure following pneumonectomy for penetrating thoracic trauma [27]. Both venovenous (VV) and VA ECLS have been employed for perioperative management of patients who sustained traumatic tracheobronchial rupture to enable successful operative repair [3,8,13]. VV ECLS has been used in several patients to manage respiratory failure from extensive traumatic pulmonary contusion and hemorrhage [1,2,6,13,28].…”

“…Several case reports and small case series describe the use of ECLS in the management of pediatric and adult traumatic respiratory failure including blunt and penetrating parenchymal and tracheobronchial injuries [1][2][3][4][5][6][7][8][9][10], cardiac contusions [11][12][13], traumatic brain injury [14][15][16][17], and shock [18][19][20]. Retrospective cohort studies of trauma patients cared for at tertiary care referral centers report survival after ECLS ranging from 50-79% [21][22][23][24].…”

Bi-caval dual lumen venovenous extracorporeal membrane oxygenation and high-frequency percussive ventilatory support for postintubation tracheal injury and acute respiratory distress syndrome

“…Extracorporeal membrane oxygenation has been described in the perioperative management of tracheal and bronchial injuries [12][13][14][15]. One pediatric case report describes an attempt to use ECMO to allow healing of a tracheal injury by secondary intention; however, definitive surgical repair of the airway was ultimately necessary [12].…”