Extra Corporeal Life Support in Traumatic Brain Injury Patients

Abstract

Purpose of review: The purpose of this review is to describe recent evidence regarding the use of Extracorporeal Membrane Oxygenation (ECMO) as rescue therapy for refractory cardiac or respiratory failure in patients with traumatic brain injury (TBI) when conventional treatments have failed. The characteristics of these patients, including the risk of bleeding and developing malignant intracranial hypertension, are generally considered as relative contraindications to ECMO treatment; however, recent evidence suggests that the use of ECMO should be considered even in this cohort. Recent findings: Recent findings suggest that venous-venous (V-V) ECMO can be feasible in the treatment of severe acute respiratory distress syndrome (ARDS) TBI-related. Venousarterial (V-A) ECMO has emerged as a salvage intervention in TBI patients complicated with cardiogenic shock and after cardiac arrest. Improvement of ECMO techniques, including the introduction of centrifugal pumps and heparin-coated circuits, are progressively reducing the amount of heparin required. Moreover, the application of low dose heparin or heparinfree protocols anticoagulation in ECMO has shown good outcome and minimal bleeding and thrombotic complications. Summary: ECMO can be considered as a safe and feasible rescue therapy even in TBI patients. However, there is a lack of evidence. Further studies are warranted, focusing on brain trauma patients undergoing ECMO to better clarify the effect on survival, the type and dose of anticoagulation, and the utility of dedicated multidisciplinary trauma-ECMO units.

Utilization and Outcomes of Extracorporeal Membrane Oxygenation Following Traumatic Brain Injury in the United States

“…Compared to patients unexposed to ECMO, patients exposed to ECMO had longer median (IQR) hospital and ICU length of stay [26 days (11-36) versus 9 days (4-8) and 19.5 days (8-32) versus 5 days (2)(3)(4)(5)(6)(7)(8)(9)(10)(11), respectively] and a longer median (IQR) duration of mechanical ventilation [18 days (8-31) versus 3 days (2-8)]. 35.6% of patients who received required dialysis compared to 4.6%.…”

“…6 A limited body of evidence consisting of case reports published over the last 20 years has reported successful utilization of ECMO in severe TBI patients. 7 By leveraging procedural improvements designed to minimize the risk of intracranial bleeding including low-dose anticoagulation, 8 heparin-free utilization, 9,10 and advances in heparin-bonded circuitry, 7,11 ECMO utilization has grown considerably in recent years. The current clinical consensus, stemming from these cases and improvements in the safety and technology of ECMO practices, acknowledges the potential benefits of ECMO as a life-saving treatment for the TBI population, albeit without formal guidelines.…”

MicroRNA-31 inhibits traumatic brain injury-triggered neuronal cell apoptosis by regulating hypoxia-inducible factor-1A/vascular endothelial growth factor A axis

“…Traumatic brain injury (TBI) is the most threatening cause of disability and demise among young people [1,2]. In developed countries, more than 1.7 million people suffer from TBI every year, and the annual economic loss caused by TBI is more than 60 billion dollars [3,4].…”