Extracorporeal Membrane Oxygenation Support in Trauma Versus Nontrauma Patients with Noninfectious Acute Respiratory Failure

Abstract

The utility of extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS) of noninfectious origin remains unclear. Data on patients with ARDS of noninfectious origin who underwent ECMO were reviewed retrospectively. We compared the pre-ECMO characteristics and hospital outcomes of patients with traumatic and nontraumatic ARDS. In total, 23 patients (trauma, n = 9; nontrauma, n = 14) were included in the study. The mean patient age was 42 years, there were three females, and the mean pre-ECMO Simplified Acute Physiologic Score (SAPS) II was 60.0 (49.0-71.0). The hemoglobin level was lower and the prothrombin time (PT) more prolonged, prior to initiation of ECMO, in traumatic compared with nontraumatic ARDS patients. During the first 48 h of ECMO support, the coagulation parameters did not differ between the two groups, but the platelet counts, PT, and activated partial thromboplastin time indicated that coagulopathy was developing in all patients. The hospital and 28-day mortality rates were 21.7 and 13.0%, respectively, and serious neurological outcomes (cerebral performance category [CPC] of three points or more) developed in 26.1% of all patients; however, the extent of such outcomes did not differ between traumatic and nontraumatic ARDS patients. Upon multivariate analysis, the pre-ECMO SAPS II tended to be associated with composite events (i.e., hospital death and/or a CPC of three points or more) (P = 0.051). Additionally, a history of hypertension and an elevated pre-ECMO SAPS II were significant risk factors for serious neurological outcomes among hospital survivors (n = 18). In conclusion, ECMO support can be associated with favorable outcomes in patients with ARDS of noninfectious origin, irrespective of whether the ARDS is associated with trauma. The pre-ECMO SAPS II and a history of hypertension may be independent risk factors for poor outcomes.

Survival rate and Outcome of extracorporeal life support (ECLS) for treatment of acute cardiorespiratory failure in trauma patients

“…High serum lactic acid levels and prolonged interval from cardiac arrest to ECLS had negative impact on neurological performance at discharge 22 . In the present study long-term survivors of traumatic cardiac arrest had a satisfying neurological performance at discharge from hospital, which might differ from current literature due to the small sample size 12,21 .…”

“…Kim et al . reported satisfying neurological outcome with an average CPC of 1 (1–2.5) in patients with ECLS following traumatic cardiorespiratory or traumatic ARDS 21 . In contrast Ryu et al .…”

Influence of immunosuppression in patients with severe acute respiratory distress syndrome on veno‐venous extracorporeal membrane oxygenation therapy

“…4 However, the outcome is strongly dependent on the underlying etiology of ARDS and the concomitant diseases and conditions, especially the presence of immunosuppression. [5][6][7][8][9]…”

Use of Extracorporeal Membrane Oxygenation in Blunt Traumatic Injury Patients with Acute Respiratory Distress Syndrome

“…There are an increasing number of studies that suggest that ECMO is a safe and viable organ support option for trauma patients with ARDS. [5][6][7][8] Patients requiring VA ECMO support maybe at increased risk of adverse outcomes. Extracorporeal membrane oxygenation may serve as an additional support modality in adult patients with severe traumatic lung injury or acute respiratory failure and ARDS with refractory hypoxemia.…”