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

Abstract

Introduction The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in trauma patients has been controversial, but VV-ECMO plays a crucial role when the lungs are extensively damaged and when conventional management has failed. VV-ECMO provides adequate tissue oxygenation and an opportunity for lung recovery. However, VV-ECMO remains contraindicated in patients with a risk of bleeding because of systemic anticoagulation during the treatment. The most important point is controlling the bleeding from severe trauma. Case A 32-year-old male experienced blunt trauma due to a traffic accident. He presented with bilateral hemopneumothorax and bilateral flail chest. We performed emergency thoracotomy for active bleeding and established circulatory stability. After surgery, the oxygenation deteriorated under mechanical ventilation, so we decided to establish VV-ECMO. However, bleeding from the bilateral lung contusions increased after VV-ECMO was established, and the patient was switched to heparin-free ECMO. After conversion, we could control the bronchial bleeding, especially the lung hematomas, and the oxygenation recovered. The patient was discharged without significant complications. VV-ECMO and mechanical ventilation were stopped on days 10 and 11, respectively. He was discharged from the ICU on day 15. Conclusion When we consider the use of ECMO for patients with uncontrollable, severe bleeding caused by blunt trauma, it may be necessary to use a higher flow setting for heparin-free ECMO than typically used for patients without trauma to prevent thrombosis.

Life-threatening antineutrophil cytoplasmic antibody–associated vasculitis after influenza A H1N1 infection requiring veno-venous extracorporeal membrane oxygenation

“…Indeed, there are several reports of heparin-free ECMO implementation in trauma patients, without significant related complications, using higher blood flow, to avoid thrombosis of the circuit. 9 Our patient was transfused with eight red blood cell units during ECMO support, which is consistent with the reported blood transfusion strategies in VV-ECMO. 10 Another concern of ECMO use in immunocompromised patients is the risk of infections associated with insertion of cannulas.…”

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

“…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 ].…”

“…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 ]. To gain the greatest benefit, a decision to initiate ECMO should not be delayed [ 209 , 213 , 214 , 219 ].…”

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

“…[8][9][10][11] There are successful reports of prolonged heparin-free ECMO use in patients with trauma as well as other pathologies that retain a high risk of bleeding complications. 4,12 Due to the debate of ECMO's role in trauma, a retrospective study was proposed at our center, which has both a high level of ECMO and trauma expertise. The objective of this study was to assess the use of VV ECMO in the trauma patient population to determine mortality and complication rates.…”