Successful Management of Adult Smoke Inhalation with Extracorporeal Membrane Oxygenation

Abstract

Pulmonary complications remain one of the leading causes of mortality in patients with burns. We report two cases of adult patients with thermal and inhalation injuries who were placed on extracorporeal membrane oxygenation (ECMO) and survived. Patient 1 was a 42-year-old male who suffered 15% TBSA and a severe inhalation injury requiring intubation upon arrival to the emergency department. Patient 2 was a 24-year-old female in a house fire who received 20%TBSA and was noted to be in respiratory distress and intubated on the scene by the paramedic team. Three days after admission, patient 1 developed severe respiratory failure. He decompensated, despite maximum conventional management, and was placed on ECMO. After 300 hours of ECMO, his pulmonary function had improved, and he was decannulated. Patient 2 also developed severe refractory respiratory failure and was placed on ECMO. She was decannulated 288 hours later. Both patients were discharged home shortly afterwards and have managed well. ECMO should be considered when patients are facing a respiratory death from inhalation injury on conventional mechanical ventilation.

Extracorporeal membrane oxygenation as a lifesaving modality in the treatment of pediatric patients with burns and respiratory failure

“…Although these cases have illustrated the feasibility of using ECMO as a lifesaving treatment of burn-related respiratory failure, they have provided a biased view of morbidity and mortality for this patient population. In the 23 pediatric cases reported, 18 (74%) survived to hospital discharge [2,[5][6][7][8][9][10][11], whereas 7 (78%) of the 9 adult cases reported survived to hospital discharge [12][13][14][15][16][17]. Our study is the first to examine this subset of patients from the ELSO registry and demonstrates a lower overall survival rate (53% compared with 74%), indicating bias in the previously reported case series.…”

“…The case involved an 11-month-old male infant with 32% TBSA scald burns who developed ARDS, required VA ECMO support for 28 days, and survived to discharge home. Since then, there have been multiple case reports and case series describing the experience of single institutions with ECMO in the treatment of respiratory failure in patients with both flame and scald burn injuries [2,[5][6][7][8][9][10][11][12][13][14][15][16][17]. Although these cases have illustrated the feasibility of using ECMO as a lifesaving treatment of burn-related respiratory failure, they have provided a biased view of morbidity and mortality for this patient population.…”

“…The use of ECMO has been extended to the treatment of pediatric and adult burn patients that suffer severe acute respiratory distress syndrome (ARDS) and inhalation injury [2,[5][6][7][8][9][10][11][12][13][14][15][16][17]. Twenty-three pediatric cases using ECMO as a treatment modality for burn-related respiratory failure have been reported in the literature for both flame and scald burns [2,[5][6][7][8][9][10][11].…”

Key Questions in Ventilator Management of the Burn-Injured Patient (Second of Two Parts)

“…Recent reports document continued episodic use of ECMO in burn-injured patients. 59,60 Central venous access can also be used for extracorporeal carbon dioxide removal with the majority of oxygen exchange occurring via the native lungs. Carbon dioxide removal can be accomplished with a lower circuit flow rate than is required for venovenous ECMO.…”

Das Inhalationstrauma – Epidemiologie, Diagnostik und Therapie

“…Es gelten prinzipiell die gleichen Voraussetzungen wie auch bei anderen kritisch kranken Patienten, allerdings kommt bei Brandverletzten noch die Einschätzung der Wundsituation dazu [70]: vor allem nach Spalthautanlage ist Vorsicht geboten, um nicht durch Scherkräfte die aufgelegte Haut zu schädigen oder durch Druck auf die Wunde ein Anheilen des Transplantats zu verhindern. Auch über den Einsatz einer veno-venösen extrakorporalen Membranoxygenierung (ECMO) am Brandverletzten existieren Fallberichte [66].…”