Extracorporeal membrane oxygenation resuscitation for traumatic brain injury after decompressive craniotomy

Yen, Tsan-Shin; Liau, Chun-Chih; Chen, Yih‐Sharng; Chao, Anne

doi:10.1016/j.clineuro.2007.10.017

Cited by 36 publications

(28 citation statements)

References 6 publications

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“…6 Yen et al used a heparin-bonded ECMO circuit for a patient after a decompressive craniectomy and avoided the need for systemic heparin. 42 A recent report by Bruzek et al demonstrated a similar lifesaving use of ECMO and systemic heparin in a patient with acute respiratory distress syndrome following a trauma craniectomy. 3 Our case is the first report of the use of ECMO in an adult with MMD who was successfully resuscitated without any neurological injury.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 Our report and these other cases, however, demonstrate that ECMO can be instituted in a craniotomy patient after cardiopulmonary collapse without significant intracranial bleeding or neurological sequelae. 42 Mild hypothermia has been shown to improve the neurological outcome in patients when administered after the global cerebral ischemic event following cardiac arrest from ventricular fibrillation 3,38 or perinatal hypoxicischemic injury. 16,32 Therapeutic mild hypothermia is now considered a standard of care and is recommended as a guideline for patients with cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

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Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report

Choudhri

Shah

Basarab-Tung

et al. 2015

JNS

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C ardiopulmonary bypass using the heart-lung machine was initiated in 1937 by Gibbons and subsequently has been used for open cardiac surgery since 1954. 15 However, given the limitations of membrane oxygenation, it could not be used for long durations. 41 This gave way to the development of extracorporeal membrane oxygenation (ECMO) in 1972 by Hill et al. 18,31 ECMO is a last-resort intensive care technique indicated during cardiopulmonary failure due to potentially reversible causes. ECMO provides circulatory support by assuming the role of the heart and lungs to maintain blood flow and oxygenation to the vital organs, including the brain.14 Most data on the success of ECMO come from its primary indication for respiratory failure in newborns. Four prospective randomized controlled trials in newborns and one in adults have shown a significant survival advantage with ECMO for severe respiratory distress. 11,29 The data and indications for ECMO in the setting of cardiac failure are still evolving. Conventional extracorporeal circuits are routinely used in elective cardiac surgery where the right atrium and aorta are directly cannulated to allow unobstructed flow. 15Although ECMO is derived from cardiopulmonary bypass, differences between them include minimal heparin use, peripheral cannulation, lack of a cardiotomy reservoir, and no autotransfusion. Since these early developments, ECMO has transiabbreviatioNs CPR = cardiopulmonary resuscitation; EC-IC = extracranial-to-intracranial; ECMO = extracorporeal membrane oxygenation; ECPR = extracorporeal CPR; MMD = moyamoya disease; VA = venoarterial; VV = veno-venous. The authors describe the case of a 51-year-old man with bilateral moyamoya disease and prior strokes who developed an asystolic cardiac arrest while undergoing revascularization surgery under mild hypothermia. The patient was successfully treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) after manual cardiopulmonary resuscitation (CPR) was unsuccessful for 45 minutes. ECMO is a cardiopulmonary support system that is indicated for respiratory failure in pediatric and adult patients. It is increasingly being used as an extension to mechanical CPR for patients who have suffered cardiac arrest if the underlying cause of cardiac arrest is thought to be reversible. Identifying which patients should be placed on emergency ECMO after cardiac arrest is controversial given its high morbidity and mortality. ECMO in neurosurgical settings has associated risks of intracranial hemorrhage and neurological compromise, while resource utilization is paramount given the high costs of this treatment. This paper is significant because it describes the use of ECMO in an unindicated setting. Limited data are available for ECMO usage after cardiac arrest with baseline cerebral ischemia. Furthermore, this paper raises important considerations for extracorporeal CPR use in a patient who had recently undergone craniotomy. The patient in this report remained on ECMO for 48 hours, after which he was successfu...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report

Choudhri

Shah

Basarab-Tung

et al. 2015

JNS

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“…vvECMO is being used increasingly with traumatic central nervous system injury, even in the presence of hemorrhage [18,45,66]. Reports and series of patients undergoing ECMO with TBI and intracranial hemorrhage are increasing [67].…”

Section: Head Injuriesmentioning

confidence: 99%

“…ARDS is a clinical diagnosis made based on physiologic parameters including the PaO2/FiO2 ratio and can result from a range of causes of acute lung injury in trauma patients, including large pulmonary contusion, fat embolism from long bone and pelvic fractures [6,17,51], near drowning and burns [27,52], massive transfusion [4] (Fig. 4), TBI, rapid core rewarming [1,45], or as a complication of multi-organ system failure [4,18]. Survival rates in patients with end-stage lung dysfunction have been reported in the range of 37-50 % with conventional ventilator strategies [51,53].…”

Section: Chest Injuriesmentioning

confidence: 99%

Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know

2015

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The purpose of this article is to review the spectrum of severe traumatic injuries treatable with ECMO and their imaging features, considerations for cannula placement, and complications that may arise in polytraumatized patients on extracorporeal life support. Recent major advances in miniaturization and biocompatibility of ECMO devices have dramatically increased their safety profile and expanded the application of ECMO to patients with severe polytrauma.

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“…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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Extracorporeal membrane oxygenation resuscitation for traumatic brain injury after decompressive craniotomy

Cited by 36 publications

References 6 publications

Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report

Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report

Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know

Outcomes of Extracorporeal Life Support in Trauma

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