Extracorporeal life support in post-traumatic respiratory distress patients

Huang, Yao‐Kuang; Liu, Kou-Sheng; Lu, Ming‐Shian; Wu, Meng-Yu; Tsai, Feng‐Chun; Lin, Pyng Jing

doi:10.1016/j.resuscitation.2009.02.016

Cited by 42 publications

(43 citation statements)

References 10 publications

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“…ECMO may thus provide an additional treatment modality in patients with severe traumatic lung injury with ALF that does not respond to conventional treatment and ventilatory regimes [8]. Recently, ECMO therapy also presents a rescue therapy in severe trauma patients with concomitant chest injury suffering from refractory ALF when conventional therapies have been exhausted [2,18]. In previous reports, ELS devices have been safely used in adult trauma patients with multiple injuries and severe pulmonary failure with an improved survival after early implementation [9].…”

Section: Discussionmentioning

confidence: 99%

“…In recent databases, patients with multiple trauma are reported to suffer from associated chest injury in nearly 50% of cases [1]. However, only a minority of patients develop post-traumatic respiratory insufficiency that mandates intubation and mechanical ventilation [2]. Generally, the management of both blunt and penetrating thoracic injuries is supportive and should aim to minimize the systemic inflammatory response syndrome and its progression to acute lung failure (ALF) or acute respiratory distress syndrome (ARDS) [3].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the impact of ECMO support in patients with severe pulmonary failure due to traumatic life-threatening injuries remains controversial especially due to the risk of bleeding complications, and its application is limited to a few experienced centers [2,12]. …”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

Ried¹,

et al. 2013

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IntroductionSevere trauma with concomitant chest injury is frequently associated with acute lung failure (ALF). This report summarizes our experience with extracorporeal lung support (ELS) in thoracic trauma patients treated at the University Medical Center Regensburg.MethodsA retrospective, observational analysis of prospectively collected data (Regensburg ECMO Registry database) was performed for all consecutive trauma patients with acute pulmonary failure requiring ELS during a 10-year interval.ResultsBetween April 2002 and April 2012, 52 patients (49 male, three female) with severe thoracic trauma and ALF refractory to conventional therapy required ELS. The mean age was 32 ± 14 years (range, 16 to 72 years). Major traffic accident (73%) was the most common trauma, followed by blast injury (17%), deep fall (8%) and blunt trauma (2%). The mean Injury Severity Score was 58.9 ± 10.5, the mean lung injury score was 3.3 ± 0.6 and the Sequential Organ Failure Assessment score was 10.5 ± 3. Twenty-six patients required pumpless extracorporeal lung assist (PECLA) and 26 patients required veno-venous extracorporeal membrane oxygenation (vv-ECMO) for primary post-traumatic respiratory failure. The mean time to ELS support was 5.2 ± 7.7 days (range, <24 hours to 38 days) and the mean ELS duration was 6.9 ± 3.6 days (range, <24 hours to 19 days). In 24 cases (48%) ELS implantation was performed in an external facility, and cannulation was done percutaneously by Seldinger's technique in 98% of patients. Cannula-related complications occurred in 15% of patients (PECLA, 19% (n = 5); vv-ECMO, 12% (n = 3)). Surgery was performed in 44 patients, with 16 patients under ELS prevention. Eight patients (15%) died during ELS support and three patients (6%) died after ELS weaning. The overall survival rate was 79% compared with the proposed Injury Severity Score-related mortality (59%).ConclusionPumpless and pump-driven ELS systems are an excellent treatment option in severe thoracic trauma patients with ALF and facilitate survival in an experienced trauma center with an interdisciplinary treatment approach. We encourage the use of vv-ECMO due to reduced complication rates, better oxygenation and best short-term outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

Ried¹,

et al. 2013

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“…However, ECMO has yielded promising results in these patients. [16][17][18] Experience with ECMO therapy for patients with SCI is limited. This report Although only a small number of cases were encountered over the period of this study, we achieved satisfactory results with ECMO therapy (71.4% survival).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal lung support in patients with spinal cord injury: Single center experience

Lotzien¹,

Schildhauer²,

Aach³

et al. 2016

The Journal of Spinal Cord Medicine

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Objective: Trauma-related spinal cord injury (SCI) leads to a loss of motor, sensory and vegetative functions and is disproportionately associated with respiratory complications. SCI has a significant impact on respiratory muscle function and can lead to respiratory dysfunction or severe lung failure. Participants: Between 2008 and 2014, 7 patients with severe lung failure following SCI received veno-venous extracorporeal membrane oxygenation (ECMO) n = 5 and interventional lung assist (iLA) n = 2. Results: The median duration of extracorporeal lung support was 8 (5.7-17.6) days. All 5 of the ECMOsupported patients were successfully weaned, and one of the two patients treated with iLA was weaned from the device. The median intensive care unit (ICU) stay was 35 (8.5-44.5) days. The mean hospital stay was 81 (8.5-120.7) days, and the average ventilation time was 817 (206-1,225) hours. Five (71.4%) of the 7 patients were discharged from the ICU and hospital. Conclusions: In patients with SCI, serious complications include microatelectasis, infection, ventilationperfusion mismatching and aspiration (special case: salt-water aspiration after jumping into shallow water). In patients with SCI with post-traumatic lung failure, ECMO is a feasible and life-saving procedure. After surviving spinal shock, a long rehabilitation period with intensive follow-up in specialized centers is required.

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“…[18 ] reports from March 2004 to October 2007: nine patients with posttraumatic acute respiratory distress syndrome (ARDS) had failed conventional therapies including surgical interventions. Median interval time from trauma to ECLS was 33 h (range Critical care organ system support McCunn and Reed 555…”

mentioning

confidence: 99%