Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome Caused by Anhydrous Ammonia Burns: Two Case Reports

Abstract

Acute anhydrous ammonia burns is relatively rare but lethal, and often occurs as a mass occupational incident worldwide. Anhydrous ammonia mainly lead to severe inhalation injury and skin/mucosa wound because of its high water solubility and strong alkalinity. Acute respiratory distress syndrome (ARDS) induced by inhalation injury is the main cause of death. Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, has been recommended as as the salvage treatment for severe ARDS based on low level evidence. However, the application of ECMO in ammonia burns is still limited. Here, we presented two cases of anhydrous ammonia burn patients, one 62-year-old man with 15% total body surface area (TBSA) and one 47-year-old man with 27% TBSA, accompanying severe inhalation injury. They both developed severe ARDS and started vv ECMO on 3, 6, 15 days after injury, respectively. ECMO lasted 118, 247, and 72 hours, respectively. All ECMO were successfully weaned off although only one patient survived. Meanwhile, one patient had the coagulopathy complication of ECMO, mainly including bleeding, deep vein thrombosis and hemolysis. In conclusion, this report provided evidence for use of ECMO as supportive care in ammonia burn patients with severe ARDS.

Extracorporeal Life Support in Adult Burn Care: A Systematic Review

“…The most recent publications are in line with previous findings in terms of indications for ECMO support in burn and inhalation injuries. [46][47][48][49] The case report by Bubenek-Turconi et al 46 advocates the combined use of renal replacement therapy and haemoadsorption as a way to reduce the pro-inflammatory response during V-V ECMO support in a 41-year-old male sustaining inhalation and burn injury with 25% TBSA, complicated by pneumonia and septic shock. Heng et al 47 discuss two patients sustaining ammonia burn and inhalation injury with 50% survival.…”

“…[46][47][48][49] The case report by Bubenek-Turconi et al 46 advocates the combined use of renal replacement therapy and haemoadsorption as a way to reduce the pro-inflammatory response during V-V ECMO support in a 41-year-old male sustaining inhalation and burn injury with 25% TBSA, complicated by pneumonia and septic shock. Heng et al 47 discuss two patients sustaining ammonia burn and inhalation injury with 50% survival. The case series by Huang et al is a retrospective analysis of 14 patients sustaining severe burn and inhalation injury complicated by ARDS with 47.7%-99%.…”