Extrakorporale Membranoxygenierung und schweres Schädel-Hirn-Trauma

Muellenbach, R.M.; Redel, Andreas; Küstermann, J.; Brack, Alexander; Gorski, Armin; Rösner, Thomas A.; Roewer, Norbert; Wurmb, Thomas

doi:10.1007/s00101-011-1872-5

Cited by 15 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A case report evaluated the management of venovenous ECMO without systemic anticoagulation in a patient with severe lung and brain injuries. [ 17 ] Another case series reported that patients with traumatic brain injury who received ECMO support had a relatively high survival rate and a low rate of neurologic sequelae. [ 18 ] Even patients with intracranial hemorrhage who required craniotomy exhibited a more favorable outcome with the use of ECMO.…”

Section: Discussionmentioning

confidence: 99%

The use of extracorporeal membrane oxygenation in trauma patients

et al. 2018

View full text Add to dashboard Cite

Extracorporeal membrane oxygenation (ECMO) has been increasingly applied for the treatment of patients with trauma. Because a common complication of ECMO is bleeding, the use of ECMO support for patients with trauma was limited in the past. Studies have demonstrated a survival benefit from ECMO support in cases of traumatic lung injury, and it is likely that patients with other types of trauma would also benefit from ECMO support. However, the effect of ECMO in patients with other types of trauma is unknown.Using the national insurance data of Taiwan, we identified 810 patients with trauma who received ECMO support from 2000 to 2010. Patients who died or who withdrew from the program within 7 days after discharge were defined as deceased. Logistic regression was used to estimate the odds ratio (OR) of death and 95% confidence intervals (CIs).The overall mortality was 32.8% (266/810). A total of 417 patients received surgery during hospitalization, with an overall mortality of 39.0% (163/417). Patients who underwent thoracic surgery had an OR of 2.23 (95% CI: 1.49–3.34) compared with those who did not. Patients who underwent brain surgery had an OR of 2.86 (95% CI: 1.37–5.98) compared with patients who did not. Patients who received abdominal surgery had an OR of 4.47 (95% CI: 2.63–7.61) compared with patients who did not. All types of surgery had odds of mortality except orthopedic surgery; the use of ECMO with orthopedic surgery had an OR of 1.06 (95% CI: 0.69–1.62) compared with patients who did not receive orthopedic surgery.Except for orthopedic surgery, patients with trauma who received ECMO support and required further surgery during hospitalization exhibited a relatively high mortality rate.

show abstract

Section: Discussionmentioning

confidence: 99%

The use of extracorporeal membrane oxygenation in trauma patients

et al. 2018

View full text Add to dashboard Cite

show abstract

“…ECMO has been proved to be an rescue therapy when conventional methods are ineffective. ECMO was also reported to be effective in polytraumatic patients combining pulmonary contusion and other organ damage including bronchial rupture [2,4], endobronchial hemorrhage [5], blunt abdominal trauma (BAT) with internal bleeding necessitating exploratory laparotomy [6], or traumatic brain injury [7-10]. However, the use of ECMO on patients with a preexisting bleeding risk without need of immediate operation is still rarely reported.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…TBI was previously contraindicated for ECMO due to the heightened risk of intracranial hemorrhage from systemic anticoagulation [ 30 , 60 , 61 ]. Recently, advancements in procedures have mitigated this bleeding risk, including low-dose anticoagulation [ 29 , 33 ], delayed anticoagulation (after 48–72 h) [ 9 , 37 ], heparin-free application [ 36 , 41 ], and improved heparin-binding circuits [ 21 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Positive outcomes have been observed even in TBI patients undergoing craniotomy for intracranial hemorrhage [ 62 ]. Although concerns exist about possible worsening of intracranial hemorrhage with systemic anticoagulation during ECMO [ 60 ], a study conducted by Parker et al [ 14 ] supported the use of VV ECMO therapy in TBI patients, with 6 out of 13 patients receiving systemic anticoagulation, as no deterioration in intracranial hemorrhage was observed. In a study by Kruit et al [ 15 ], 19 TBI patients were supported on ECMO, with 12 of them receiving anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

ECMO in adult patients with severe trauma: a systematic review and meta-analysis

Zhang,

Huang

et al. 2023

Eur J Med Res

View full text Add to dashboard Cite

Background Severe trauma can result in cardiorespiratory failure, and when conventional treatment is ineffective, extracorporeal membrane oxygenation (ECMO) can serve as an adjunctive therapy. However, the indications for ECMO in trauma cases are uncertain and clinical outcomes are variable. This study sought to describe the prognosis of adult trauma patients requiring ECMO, aiming to inform clinical decision-making and future research. Methods A comprehensive search was conducted on Pubmed, Embase, Cochrane, and Scopus databases until March 13, 2023, encompassing relevant studies involving over 5 trauma patients (aged ≥ 16 years) requiring ECMO support. The primary outcome measure was survival until discharge, with secondary measures including length of stay in the ICU and hospital, ECMO duration, and complications during ECMO. Random-effects meta-analyses were conducted to analyze these outcomes. The study quality was assessed using the Joanna Briggs Institute checklist, while the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results The meta-analysis comprised 36 observational studies encompassing 1822 patients. The pooled survival rate was 65.9% (95% CI 61.3–70.5%). Specifically, studies focusing on traumatic brain injury (TBI) (16 studies, 383 patients) reported a survival rate of 66.1% (95% CI 55.4–76.2%), while studies non-TBI (15 studies, 262 patients) reported a survival rate of 68.1% (95% CI 56.9–78.5%). No significant difference was observed between these two survival comparisons (p = 0.623). Notably, studies utilizing venoarterial extracorporeal membrane oxygenation (VA ECMO) (15 studies, 39.0%, 95% CI 23.3–55.6%) demonstrated significantly lower survival rates than those using venovenous extracorporeal membrane oxygenation (VV ECMO) (23 studies, 72.3%, 95% CI 63.2–80.7%, p < 0.001). The graded assessment of evidence provided a high degree of certainty regarding the pooled survival. Conclusions ECMO is now considered beneficial for severely traumatized patients, improving prognosis and serving as a valuable tool in managing trauma-related severe cardiorespiratory failure, haemorrhagic shock, and cardiac arrest.

show abstract

Extrakorporale Membranoxygenierung und schweres Schädel-Hirn-Trauma

Cited by 15 publications

References 17 publications

The use of extracorporeal membrane oxygenation in trauma patients

The use of extracorporeal membrane oxygenation in trauma patients

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

ECMO in adult patients with severe trauma: a systematic review and meta-analysis

Contact Info

Product

Resources

About