Extracorporeal membrane oxygenation in trauma: A single institution experience and review of the literature

Strumwasser, Aaron; Tobin, Joshua M.; Henry, Reynold; Guidry, Chrissy; Park, Caroline; Inaba, Kenji; Δημητριάδης, Δημήτριος

doi:10.1177/0391398818794111

Cited by 19 publications

(14 citation statements)

References 45 publications

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“…Over 59% of our patients had ECMO started within 48 hours of admission. On the contrary, in a study of 7 trauma patients by Strumwasser et al [27], the survivors had ECMO initiated later than non-survivors (15 vs 7.8 days).The ELSO registry study [12], demonstrated the mean duration of extracorporeal life support was 8.8±9.5 days which is slightly higher [median 9.5 (1-29) days] in our cohort.…”

Section: Discussioncontrasting

confidence: 70%

Outcomes of Post-traumatic Acute respiratory distress syndrome (ARDS) with and without Extracorporeal membrane oxygenation (ECMO) at A Level-1 Trauma Center

Al-Thani

Al-Hassani

El‐Menyar

et al. 2021

Preprint

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Purpose: We aimed to evaluate the outcomes of post-traumatic acute respiratory distress syndrome (ARDS) in patients with and without Extracorporeal membrane oxygenation (ECMO) support.Methods: A retrospective analysis was conducted for trauma patients who developed ARDS at a level I trauma facility between 2014 and 2020. Data were analyzed and compared between ECMO and non-ECMO group.Results: We identified 85 patients with ARDS (22 patients had ECMO support and 63 matched patients managed by the conventional mechanical ventilation. The two groups were comparable for age, sex, injury severity score, abbreviated injury score, shock index, SOFA score, and head injury. Kaplan Meier survival analysis showed that the survival in the ECMO group was initially close to that of the non-ECMO, however, during follow-up, the survival rate was better in the ECMO group, but did not reach statistical significance (Log-rank, p=0.43 and Tarone-Ware, p=0.37). Multivariable logistic regression analysis showed that acute kidney injury (AKI) (Odds ratio 13.03; 95% CI 3.17-53.54) and brain edema (Odds ratio 4.80; 95% CI 1.10-21.03) were independent predictors of mortality. Sub-analysis showed that in patients with severe Murray Lung Injury (MLI) scores, non-ECMO group had higher mortality than the ECMO group (100% vs 36.8%, p=0.004).Conclusion: Although ARDS is uncommon in trauma patients, it has a high mortality. ECMO therapy was used in a quarter of ARDS cases. AKI and brain edema were the predictors of mortality among ARDS patients. ECMO use did not worsen the outcome in trauma patients; however, the survival was better in those who had severe MLI and ECMO support. Further prospective study is needed to define the appropriate selection criteria for the use of ECMO to optimize the outcomes in trauma patients.

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Section: Discussioncontrasting

confidence: 70%

Outcomes of Post-traumatic Acute respiratory distress syndrome (ARDS) with and without Extracorporeal membrane oxygenation (ECMO) at A Level-1 Trauma Center

Al-Thani

Al-Hassani

El‐Menyar

et al. 2021

Preprint

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“…Extended advanced monitoring is suggested to detect early deterioration, ideally as a baseline before initiation of ECMO to prevent potentially deleterious bleeding or thromboembolic complications [ 201 , 202 ]. Using extracorporeal lung assist has been reported in various circuit compositions, with all of these reports describing feasibility without an increased risk of bleeding and survival benefits, as well as high survival rates [ 161 , 162 , 203 , 204 , 205 , 206 , 207 , 208 , 209 , 210 , 211 , 212 , 213 , 214 , 215 , 216 , 217 ]. Some authors even reported using it in severe bleeding situations [ 158 , 216 , 217 , 218 ].…”

Section: Factors Excluded As Contraindications/additional Contraindications Onlymentioning

confidence: 99%

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Harnisch

Moerer

2021

Membranes

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(1) Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used for acute respiratory failure with few absolute but many relative contraindications. The provider in charge often has a difficult time weighing indications and contraindications to anticipate if the patient will benefit from this treatment, a decision that often decides life and death for the patient. To assist in this process in coming to a good evidence-based decision, we reviewed the available literature. (2) Methods: We performed a systematic review through a literature search of the MEDLINE database of former and current absolute and relative contraindications to the initiation of ECMO treatment. (3) Results: The following relative and absolute contraindications were identified in the literature: absolute—refusal of the use of extracorporeal techniques by the patient, advanced stage of cancer, fatal intracerebral hemorrhage/cerebral herniation/intractable intracranial hypertension, irreversible destruction of the lung parenchyma without the possibility of transplantation, and contraindications to lung transplantation; relative—advanced age, immunosuppressed patients/pharmacological immunosuppression, injurious ventilator settings > 7 days, right-heart failure, hematologic malignancies, especially bone marrow transplantation and graft-versus-host disease, SAPS II score ≥ 60 points, SOFA score > 12 points, PRESERVE score ≥ 5 points, RESP score ≤ −2 points, PRESET score ≥ 6 points, and “do not attempt resuscitation” order (DN(A)R status). (4) Conclusions: We provide a simple-to-follow algorithm that incorporates absolute and relative contraindications to the initiation of ECMO treatment. This algorithm attempts to weigh pros and cons regarding the benefit for an individual patient and hopefully assists caregivers to make better, informed decisions.

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“…Trauma patients with severe injuries are at risk of ARDS via direct and indirect causes, including lung contusions, aspiration pneumonia, massive blood transfusion and fat embolism syndrome [11]. ARDS remains a common post-traumatic complication and is diagnosed in 6.5% of patients requiring mechanical ventilation for > 48 h [12].…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Kim

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Therapeutic extracorporeal membrane oxygenation (ECMO) is a challenging procedure in patients who have experienced severe trauma. Particularly, patients with traumatic lung injury and posttraumatic acute respiratory distress syndrome (ARDS) have a high risk of bleeding during this procedure. This study aimed to determine the safety and feasibility of ECMO in patients with traumatic ARDS. Methods: We retrospectively reviewed medical records and investigated the clinical outcomes of ECMO in 42 patients with traumatic ARDS, among whom near-drowning (42.9%) was the most frequent cause of injury. Results: Thirty-four of 42 patients (81%) survived and were discharged after a median hospital stay of 23 days. A multivariate analysis identified a lactate level (odds ratio: 1.493, 95% confidence interval: 1.060-2.103, P = 0.022) and veno-venous (VV) ECMO (odds ratio: 0.075, 95% confidence interval: 0.006-0.901, P = 0.041) as favorable independent predictors of survival in patients with traumatic ARDS who underwent ECMO. The optimal cut off value for pre-ECMO lactate level was 10.5 mmol/L (area under the curve = 0.929, P = 0.001). In Kaplan-Meier analysis, the survival rate at hospital discharge was significant higher among the patients with a pre-ECMO lactate level of 10.5 mmol/L or less compared with patients with pre-ECMO lactate level greater than 10.5 mmol/L (93.8% versus 40.0%, respectively; P = 0.01). Conclusions: ECMO yielded excellent survival outcomes, particularly in patients with low pre-treatment lactate levels who received VV ECMO. Therefore, ECMO appears safe and highly feasible in a carefully selected population of trauma patients.

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Extracorporeal membrane oxygenation in trauma: A single institution experience and review of the literature

Abstract: Extracorporeal membrane oxygenation use in the trauma patient in extremis is not standard; however, this article demonstrates that extracorporeal membrane oxygenation is feasible in a complex, heterogeneous patient population when treated at designated centers.

Cited by 19 publications

References 45 publications

Outcomes of Post-traumatic Acute respiratory distress syndrome (ARDS) with and without Extracorporeal membrane oxygenation (ECMO) at A Level-1 Trauma Center

Outcomes of Post-traumatic Acute respiratory distress syndrome (ARDS) with and without Extracorporeal membrane oxygenation (ECMO) at A Level-1 Trauma Center

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

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

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