Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Abstract

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

Veno-venous Extracorporeal Membrane Oxygenation in Patients with Traumatic Brain Injuries and Severe Respiratory Failure: A Single-Center Retrospective Analysis

“…12,26 While still a relatively new practice, multiple prior studies have explored the feasibility and safety of VV ECMO in the general trauma population. [27][28][29][30][31][32][33][34][35][36] Our study demonstrates that patients with TBI on VV ECMO have similar observed mortality rates as trauma patients without TBI. Survivors in this patient population had largely independent-functioning neurologic outcomes despite presenting with severely depressed GCS.…”

“…Regardless of the pulmonary pathology, VV ECMO is used in patients with respiratory failure refractory to conventional management 12,26 . While still a relatively new practice, multiple prior studies have explored the feasibility and safety of VV ECMO in the general trauma population 27–36 …”

Safety of tracheostomy during extracorporeal membrane oxygenation support: A single‐center experience

“…Dimopoulos et al in their series of patients on V‐V ECMO who received percutaneous tracheostomy showed an ICU mortality of 28% 11 . As reported by Salas et al, 22 both approaches can be considered in patients on ECMO as they display a similar safety profile. No significant differences were reported regarding major bleeding, procedural‐related death, or complication rates (i.e., tracheostomy false track, loss of airway, or tracheal or esophageal injury).…”

The Application Value of CT Radiomics Combined with Clinical Parameters in Predicting the Duration of Invasive Mechanical Ventilation in Patients with Traumatic Brain Injury

“…In mechanically ventilated trauma patients, a higher ISS is often associated with a longer duration of mechanical ventilation. [21][22][23] Serum ALB is a nutritional marker that can also in uence the duration of IMV in TBI patients. Low levels of ALB are a useful prognostic marker as they result from increased leakage of albumin from capillaries into the interstitial uid due to systemic in ammatory response syndrome, which has been observed in ICU patients.…”