Extracorporeal membrane oxygenation support in post-traumatic cardiopulmonary failure

Abstract

Patients with multiple traumas associated with cardiopulmonary failure have a high mortality rate; however, such patients can be temporarily stabilized using extracorporeal membrane oxygenation (ECMO), providing a bridge to rescue therapy. Using a retrospective study design, we aimed to clarify the prognostic factors of post-traumatic ECMO support.From March 2006 to July 2016, 43 adult patients (mean age, 37.3 ± 15.2 years; 7 females [16.3%]) underwent ECMO because of post-traumatic cardiopulmonary failure. Pre-ECMO demographics, peri-ECMO events, and post-ECMO recoveries were compared between survivors and nonsurvivors.The most common traumatic insult was traffic collision (n = 30, 69.8%), and involved injury areas included the chest (n = 33, 76.7%), head (n = 14, 32.6%), abdomen (n = 21, 48.8%), and fractures (n = 21, 48.8%). Fifteen patients (34.9%) underwent cardiopulmonary resuscitation and 22 (51.2%) received rescue interventions before ECMO deployment. The mean time interval between trauma and ECMO was 90.6 ± 130.1 hours, and the mode of support was venovenous in 26 patients (60.5%). A total of 26 patients (60.5%) were weaned off of ECMO and 22 (51.6%) survived to discharge, with an overall mean support time of 162.9 ± 182.7 hours. A multivariate regression analysis identified 2 significant predictors for in-hospital mortality: an injury severity score (ISS) >30 (odds ratio [OR], 9.48; 95% confidence interval [CI], 1.04–18.47; P = 0.042), and the requirement of renal replacement therapy (RRT) during ECMO (OR, 8.64; 95% CI, 1.73–26.09; P = 0.020). These two factors were also significant for the 1-year survival (ISS >30: 12.5%; ISS ≤30, 48.1%, P = 0.001) (RRT required, 15.0%; RRT not required, 52.2%, P = 0.006).Using ECMO in selected traumatized patients with cardiopulmonary failure can be a salvage therapy. Prompt intervention before shock-impaired systemic organ perfusion and acute renal failure, especially in high ISS patients, is crucial for both hospital and one-year survival.

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

“…[26][27][28][29][30][31][32] Similar to VV bypass for complex hepatic trauma, flows can be adjusted to account for blood loss and allow for the repair of venous injuries. 33 VA ECMO can support the failing heart in patients with pre-existing cardiac disease, 34 as well as provide neuroprotection following cardiac arrest. 35 ECMO may offer further advantage by attenuating inflammation due to ischemia-reperfusion injury if used in conjunction with cytokine adsorption.…”

A case report: Veno-venous extracorporeal membrane oxygenation for severe blunt thoracic trauma

“…However, ECLS remains infrequently utilized in this patient population due in large part to concern regarding the risk of major hemorrhage [9]. Larger database studies have confirmed that ECLS is infrequently used in trauma patients; however, hospital survival is reported to be 44% to as high as 74.1% [10–15], similar to the reported 58% survival in the general adult respiratory ECLS population [16]. Extracorporeal membrane oxygenation (ECMO), a type of ECLS, helps maintain systemic tissue oxygenation when pulmonary function is compromised.…”

The Impact of an Advanced ECMO Program on Traumatically Injured Patients

“…Injury severity was not significantly different between our groups in the pre-and post-AEP timeframe (30 vs. 34). Some of the larger retrospective studies evaluating ISS for trauma ECMO patients demonstrated injury severity scores ranging from 26.0 to 29.5 (4,5,7). The mean injury severity score (ISS) for all trauma ECMO patients treated at our institution was slightly higher at 32.…”

“…Survival rates for trauma patients undergoing ECMO range in the literature from 44% to as high as 74.1% (3)(4)(5)(6)(7). Unfortunately, most of these studies include patients prior to the influenza pandemic of 2009, which led to rapid advances in ECMO technology, technique, and understanding.…”