Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock

Arlt, Matthias; Philipp, Alois; Voelkel, Sabine; Rupprecht, Leopold; Mueller, Thomas; Hilker, Michael; Graf, Bernhard M.; Schmid, Çhristof

doi:10.1016/j.resuscitation.2010.02.020

Cited by 232 publications

(244 citation statements)

References 25 publications

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“…7,12 The use of VA ECMO is also increasingly described for toxic ingestions resulting in intractable hemodynamic instability, as well as a range of other conditions. [13][14][15][16][17][18][19] The role of ECMO in accidental hypothermia is particularly relevant to emergency medicine; a recent review in the New England Journal of Medicine advocated the use of ECMO in cardiac arrest caused by accidental hypothermia, even if this requires transport to another centre, in patients with a core temperature less than 32uC (89.6uF) and circumstances suggesting that cooling took place prior to the arrest. 20 Dramatic survival following the use of VA ECMO during or following cardiac arrest, as occurred in our patient, has been reported.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Abu‐Laban

Migneault

Grant

et al. 2015

CJEM

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Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid-left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient's cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed. RÉ SUMÉL'oxygé nation extracorporelle sur oxygé nateur à membrane (OEOM) est un moyen de fournir une assistance cardiaque et respiratoire temporaire à des patients gravement malades. Le rô le de l'OEOM a gagné du terrain chez certains adultes aux services des urgences (SU) au cours des derniè res anné es. Sera exposé ici le cas spectaculaire d'un homme de 29 ans, soumis à l'OEOM veino-arté rielle pour un choc cardiogé nique et une insuffisance respiratoire suivant un collapsus et un arrê t cardiaque causé par un accè s prolongé de fibrillation ventriculaire, qui est survenu au SU de l'hô pital. Les moyens de ré animation mis en oeuvre avant le dé but de l'OEOM comprenaient des manoeuvres de ré animation cardiorespiratoire (RCR) pratiqué es de faç on quasi continue durant 49 minutes; 11 tentatives de dé fibrillation; l'administration de nombreux mé dicaments, dont un thrombolytique, pendant que se poursuivaient les manoeuvres de RCR; une intervention coronarienne percutané e et la pose d'une endoprothè se pour une dissection du segment moyen de l'artè re interventriculaire anté rieure et une oblité ration thrombotique; un soutien inotrope et la contrepulsion par ballon intra-aortique. Au cours des 48 heures suivant le dé but de l'OEOM, l'é tat cardiorespiratoire du patient s'est amé lioré rapidement, et celui-ci est retourné chez lui 9 jours aprè s son admission, et ce, sans souffrir de sé quelles neurologiques. Seront passé s en revue l'historique, les indications et le rô le de plus en plus grand de l'OEOM dans diverses affections, dont l'arrê t cardiaque.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Abu‐Laban

Migneault

Grant

et al. 2015

CJEM

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“…VV ECLS has been used in several patients to manage respiratory failure from extensive traumatic pulmonary contusion and hemorrhage [1,2,6,13,28]. VA ECLS has also been successfully employed in the management of cardiac failure from traumatic cardiac contusion and hemorrhagic shock [11,12,18,20].…”

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%

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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“…The main clinical applications of ECMO have been for the management of life-threatening pulmonary or cardiac failure [3,4] and for the safe transport of the critically ill patients, especially during the H1N1 pandemic [5,6]. ECMO has also been used in patients with septic shock [7], severe trauma [8], and profound hypothermia [9]. In this report, we describe our experience using ECMO to rescue a patient with severe ARDS secondary to pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Application of extracorporeal membrane oxygenation in severe ARDS secondary to pneumonia: a case report

Xi-hong

Xiu

et al. 2013

Open Medicine

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AbstractThis report describes a 24-year-old patient with marked and continuous hypoxemia resulting from severe acute respiratory distress syndrome (ARDS) secondary to pneumonia, which in turn was refractory to mechanical ventilation and other conventional adjunctive therapies. Veno-venous extracorporeal membrane oxygenation (ECMO) was applied for 14 days and resulted in significant improvement in the hypoxemia. We conclude that ECMO presents a therapeutic option for ARDS patients who fail to respond to conventional mechanical ventilation.

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Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock

Cited by 232 publications

References 25 publications

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Outcomes of Extracorporeal Life Support in Trauma

Application of extracorporeal membrane oxygenation in severe ARDS secondary to pneumonia: a case report

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