Extracorporeal membrane oxygenation for adult respiratory distress syndrome in trauma patients

Robba, Chiara; Ortu, Andrea; Bilotta, Federico; Lombardo, Alessandra; Sekhon, Mypinder S.; Gallo, Fabio; Matta, Basil F.

doi:10.1097/ta.0000000000001276

Cited by 72 publications

(61 citation statements)

References 38 publications

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“…Physicians manage these thrombotic challenges with use of anticoagulants, most commonly systemic administration of heparin. However excess anticoagulation, particularly when administered systemically, may cause bleeding problems . In fact bleeding issues are the most common complication in extracorporeal membrane oxygenation (ECMO), occurring in between 10–30% of cases, and the thrombotic complications that anticoagulation is meant to blunt, commonly lead to reduced device lifespan .…”

Section: Introductionmentioning

confidence: 99%

“…However excess anticoagulation, particularly when administered systemically, may cause bleeding problems. 13,14 In fact bleeding issues are the most common complication in extracorporeal membrane oxygenation (ECMO), occurring in between 10-30% of cases, and the thrombotic complications that anticoagulation is meant to blunt, commonly lead to reduced device lifespan. 9,[14][15][16] The risks associated with limited device blood biocompatibility and the pharmacologic interventions utilized to address this limitation clearly restrict the broader adoption of life saving extracorporeal therapies.…”

Section: Introductionmentioning

confidence: 99%

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Development of zwitterionic sulfobetaine block copolymer conjugation strategies for reduced platelet deposition in respiratory assist devices

Malkin

Lee

et al. 2018

J Biomed Mater Res

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Respiratory assist devices, that utilize ∼2 m of hollow fiber membranes (HFMs) to achieve desired gas transfer rates, have been limited in their adoption due to such blood biocompatibility limitations. This study reports two techniques for the functionalization and subsequent conjugation of zwitterionic sulfobetaine (SB) block copolymers to polymethylpentene (PMP) HFM surfaces with the intention of reducing thrombus formation in respiratory assist devices. Amine or hydroxyl functionalization of PMP HFMs (PMP-A or PMP-H) was accomplished using plasma-enhanced chemical vapor deposition. The generated functional groups were conjugated to low molecular weight SB block copolymers with N-hydroxysuccinimide ester or siloxane groups (SBNHS or SBNHSi) that were synthesized using reversible addition fragmentation chain transfer polymerization. The modified HFMs (PMP-A-SBNHS or PMP-H-SBNHSi) showed 80-95% reduction in platelet deposition from whole ovine blood, stability under the fluid shear of anticipated operating conditions, and uninhibited gas exchange performance relative to non-modified HFMs (PMP-C). Additionally, the functionalization and SBNHSi conjugation technique was shown to reduce platelet deposition on polycarbonate and poly(vinyl chloride), two other materials commonly found in extracorporeal circuits. The observed thromboresistance and stability of the SB modified surfaces, without degradation of HFM gas transfer performance, indicate that this approach is promising for longer term pre-clinical testing in respiratory assist devices and may ultimately allow for the reduction of anticoagulation levels in patients being supported for extended periods. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2681-2692, 2018.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development of zwitterionic sulfobetaine block copolymer conjugation strategies for reduced platelet deposition in respiratory assist devices

Malkin

Lee

et al. 2018

J Biomed Mater Res

View full text Add to dashboard Cite

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“…The mean injury severity score (ISS) for all trauma ECMO patients treated at our institution was slightly higher at 32. Robba et al recently presented a review of 16 studies with a total of 31 patients treated with ECMO after sustaining multitrauma (8). The median ISS in this review was found to be 66, however the ISS was available in only 5 of the 16 the studies.…”

Section: Discussionmentioning

confidence: 77%

“…Unfortunately, most of these studies include patients prior to the influenza pandemic of 2009, which led to rapid advances in ECMO technology, technique, and understanding. Robba et al recently presented a review of 16 studies with a total of 31 patients treated with ECMO after sustaining multitrauma (8). In some studies, the VA ECMO survival is reported as high as 41.2% (4) and yet in others survival is much less or zero (7).…”

Section: Discussionmentioning

confidence: 99%

The Impact of an Advanced ECMO Program on Traumatically Injured Patients

et al. 2018

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In June 2016, an advanced extracorporeal membrane oxygenation (ECMO) program consisting of a multidisciplinary team was initiated at a large level-one trauma center. The program was created to standardize management for patients with a wide variety of pathologies, including trauma. This study evaluated the impact of the advanced ECMO program on the outcomes of traumatically injured patients undergoing ECMO. A retrospective cohort study was performed on all patients sustaining traumatic injury who required ECMO support from January 2014 to September 2017. The primary outcome was to determine survival in trauma ECMO patients in the two timeframes, before and after initiation of the advanced ECMO program. Secondary outcomes included complication rates, length of stay, ventilator usage, and ECMO days. One hundred and thirty eight patients were treated with ECMO during the study period. Of the 138 patients, 22 sustained traumatic injury. Seven patients were treated in our pre-group and 15 in our post-group. The majority of patients were treated with VV ECMO. Our post group VV ECMO extracorporeal survival rate was 64% and our survival to discharge was 55%. This study demonstrated an improvement in survival after implementation of our advanced ECMO program. The implementation of a multidisciplinary trauma ECMO team dedicated to the rescue of critically ill patients is the key for achieving excellent outcomes in the trauma population.

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“…Historically, ECMO was not utilized in TBI patients because of the risk of cerebral bleeding related to the use of anticoagulation. Recently, some case reports and small case series have suggested a potential beneficial use of ECMO in TBI patients [41]. Surprisingly, nearly half of our respondents would use ECMO in TBI patients as rescue respiratory strategy.…”

Section: Rescue Strategies For Refractory Respiratory Failurementioning

confidence: 87%

VENTILatOry strategies in patients with severe traumatic brain injury: the VENTILO Survey of the European Society of Intensive Care Medicine (ESICM)

Picetti

Pelosi²,

Taccone

et al. 2020

Crit Care

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Background: Severe traumatic brain injury (TBI) patients often develop acute respiratory failure. Optimal ventilator strategies in this setting are not well established. We performed an international survey to investigate the practice in the ventilatory management of TBI patients with and without respiratory failure.Methods: An electronic questionnaire, including 38 items and 3 different clinical scenarios [arterial partial pressure of oxygen (PaO 2 )/inspired fraction of oxygen (FiO 2 ) > 300 (scenario 1), 150-300 (scenario 2), < 150 (scenario 3)], was available on the European Society of Intensive Care Medicine (ESICM) website between November 2018 and March 2019. The survey was endorsed by ESICM. Results: There were 687 respondents [472 (69%) from Europe], mainly intensivists [328 (48%)] and anesthesiologists [206 (30%)]. A standard protocol for mechanical ventilation in TBI patients was utilized by 277 (40%) respondents and a specific weaning protocol by 198 (30%). The most common tidal volume (TV) applied was 6-8 ml/kg of predicted body weight (PBW) in scenarios 1-2 (72% PaO 2 /FIO 2 > 300 and 61% PaO 2 /FiO 2 150-300) and 4-6 ml/kg/ PBW in scenario 3 (53% PaO 2 /FiO 2 < 150). The most common level of highest positive end-expiratory pressure (PEEP) used was 15 cmH 2 O in patients with a PaO 2 /FiO 2 ≤ 300 without intracranial hypertension (41% if PaO 2 /FiO 2 150-300 and 50% if PaO 2 /FiO 2 < 150) and 10 cmH 2 O in patients with intracranial hypertension (32% if PaO 2 /FiO 2 150-300 and 33% if PaO 2 /FiO 2 < 150). Regardless of the presence of intracranial hypertension, the most common carbon dioxide target remained 36-40 mmHg whereas the most common PaO 2 target was 81-100 mmHg in all the 3 scenarios. The most frequent rescue strategies utilized in case of refractory respiratory failure despite conventional ventilator settings were neuromuscular blocking agents [406 (88%)], recruitment manoeuvres [319 (69%)] and prone position [292 (63%)]. Conclusions: Ventilatory management, targets and practice of adult severe TBI patients with and without respiratory failure are widely different among centres. These findings may be helpful to define future investigations in this topic.

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Extracorporeal membrane oxygenation for adult respiratory distress syndrome in trauma patients

Abstract: Therapeutic study, level V.

Cited by 72 publications

References 38 publications

Development of zwitterionic sulfobetaine block copolymer conjugation strategies for reduced platelet deposition in respiratory assist devices

Development of zwitterionic sulfobetaine block copolymer conjugation strategies for reduced platelet deposition in respiratory assist devices

The Impact of an Advanced ECMO Program on Traumatically Injured Patients

VENTILatOry strategies in patients with severe traumatic brain injury: the VENTILO Survey of the European Society of Intensive Care Medicine (ESICM)

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