Application of ECMO in Multitrauma Patients With ARDS as Rescue Therapy

Madershahian, Navid; Wittwer, Thorsten; Strauch, Justus; Franke, Ulrich F.W.; Wippermann, Jens; Kaluza, Mirko; Wahlers, Thorsten

doi:10.1111/j.1540-8191.2007.00381.x

Cited by 92 publications

(79 citation statements)

References 27 publications

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“…With respect to blunt and penetrating thoracic trauma, venoarterial (VA) ECLS has been successfully used in managing postoperative cardiopulmonary failure following pneumonectomy for penetrating thoracic trauma [27]. Both venovenous (VV) and VA ECLS have been employed for perioperative management of patients who sustained traumatic tracheobronchial rupture to enable successful operative repair [3,8,13]. VV ECLS has been used in several patients to manage respiratory failure from extensive traumatic pulmonary contusion and hemorrhage [1,2,6,13,28].…”

Section: Discussionmentioning

confidence: 99%

“…Several case reports and small case series describe the use of ECLS in the management of pediatric and adult traumatic respiratory failure including blunt and penetrating parenchymal and tracheobronchial injuries [1][2][3][4][5][6][7][8][9][10], cardiac contusions [11][12][13], traumatic brain injury [14][15][16][17], and shock [18][19][20]. Retrospective cohort studies of trauma patients cared for at tertiary care referral centers report survival after ECLS ranging from 50-79% [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Extracorporeal Life Support in Trauma

2014

J Surg

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Background: Extracorporeal life support (ECLS) is a lifesaving treatment for critically ill trauma patients with refractory cardiopulmonary failure. The purpose of this analysis is to use a large national trauma database to characterize the use and outcomes of ECLS in trauma. Methods:Patients from centers that performed ECLS were identified from the 2007-2009 National Trauma Data Bank (NTDB). Demographic, clinical, and outcome data were abstracted. Univariate analyses were performed using chi-square, Mann-Whitney U-test, and regression analyses. Propensity score analysis and multiple regression models were developed using backwards stepwise logistic regression to identify risk factors for ECLS and predictors of mortality; p<0.05 was considered significant.Results: Forty-two centers of 682 (6%) performed ECLS on 78 of 245,950 patients (0.03%). ECLS patients were younger, more severely injured, had a longer ICU and hospital length of stay, and a higher mortality. Univariate analysis showed that ECLS patients had a significantly increased risk of death (OR 28; p<0.001). Among patients receiving ECLS, predictors of mortality included injury severity score (ISS) (OR 1.06; 95% CI 1.01-1.11; p=0.03) and cardiac arrest (OR 7.57; 95% CI 1.58-36.2; p=0.01). After propensity score adjusted logistic regression, ECLS was still a significant predictor of mortality (OR 6, 95% CI 2.76-13.1, p<0.01). Patients receiving ECLS at a center that performed 5 or more ECLS runs trended towards a lower mortality rate (27% vs. 73%, p=0.10). Conclusions:ECLS is infrequently used in the trauma setting. When compared to other trauma patients, ECLS patients are more critically ill and are at increased odds of death. Further study is required to determine which patient and hospital characteristics predict improved survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of Extracorporeal Life Support in Trauma

2014

J Surg

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“…Durch die Entwicklung von heparin beschichteten ECMOSystemen mit ver besserter Hämokompatibilität ist der Ein satz von extrakorporalen Verfahren auch bei polytraumatisierten ARDSPatienten durchführbar [13,14]. Aufgrund der rela tiv großen künstlichen Oberflächen des ECMOSystems kommt es jedoch durch den Kontakt des Blutes und der zellulären Komponenten mit diesen zu einer Akti vierung des inflammatorischen sowie des prokoagulatorischen Gerinnungssystems [15].…”

Section: Anamneseunclassified

Extrakorporale Membranoxygenierung und schweres Schädel-Hirn-Trauma

Muellenbach¹,

Redel

Küstermann³

et al. 2011

Anaesthesist

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Veno-venous extracorporeal membrane oxygenation (ECMO) may be lifesaving in multiple injured patients with acute respiratory distress syndrome (ARDS) due to chest trauma. To prevent circuit thrombosis or thromboembolic complications during ECMO systemic anticoagulation is recommended. Therefore, ECMO treatment is contraindicated in patients with intracranial bleeding. The management of veno-venous ECMO without systemic anticoagulation in a patient suffering from traumatic lung failure and severe traumatic brain injury is reported.

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“…Recent advances in the biocompatibility of polymethylpentene gas exchange membranes, tipto-tip heparin bonding, and increased portability of miniaturized battery operated stand-alone systems have decreased the risk of clotting in the circuit, membrane-related hemolysis, and hemodilution from large priming volumes [4,5,[14][15][16][17][18][19][20]. High-flow vvECMO can now be used successfully without heparinization or restriction of blood coagulation support under careful monitoring with few thromboembolic complications [5,14,19,[21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

“…Early aggressive use of ECMO in trauma can reverse the vicious cycle of metabolic acidosis, hypothermia, and coagulopathy leading to multi-organ system failure [4,[29][30][31][32][33]. Patients have traditionally been started on ECMO as a salvage therapy when trials with all other therapeutic modalities have failed [5,14,21,34], however, with the decreased dependence on anticoagulation, early implementation is increasingly being called for in the trauma surgery literature for patients with traumatic injuries or trauma-related sequelae associated with low survivability, especially for injuries involving the chest [5,14,15,17,22,24,35]. With improved resuscitation techniques and increased portability of new ECMO devices, more patients can be safely transported to the CT suite.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know

2015

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The purpose of this article is to review the spectrum of severe traumatic injuries treatable with ECMO and their imaging features, considerations for cannula placement, and complications that may arise in polytraumatized patients on extracorporeal life support. Recent major advances in miniaturization and biocompatibility of ECMO devices have dramatically increased their safety profile and expanded the application of ECMO to patients with severe polytrauma.

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Application of ECMO in Multitrauma Patients With ARDS as Rescue Therapy

Abstract: Quick encouragement of ECMO for the temporary management of gas exchange may increase survival rates in trauma patients with ARDS.

Cited by 92 publications

References 27 publications

Outcomes of Extracorporeal Life Support in Trauma

Outcomes of Extracorporeal Life Support in Trauma

Extrakorporale Membranoxygenierung und schweres Schädel-Hirn-Trauma

Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know

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