Extracorporeal membrane oxygenation support may be a lifesaving modality in patients with burn and severe acute respiratory distress syndrome: Experience of Formosa Water Park dust explosion disaster in Taiwan

Chiu, Yu Jen; Ma, Hsu; Liao, Wen Chieh; Shih, Yu Chung; Chen, Mei Chun; Shih, Chun Che; Chen, Tai Wei; Perng, Cherng Kang

doi:10.1016/j.burns.2017.06.013

Cited by 21 publications

(24 citation statements)

References 34 publications

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“…In recent decades, ECMO has become an essential tool in the care of patients with severe cardiac and pulmonary dysfunctions that are refractory to conventional management [10,11,50]. [23,[25][26][27][28][29][30][31]. In this study, our meta-analysis revealed a pooled SMR of 2.07, suggesting a two-fold higher mortality rate compared to the predicted mortality in patients receiving ECMO therapy.…”

Section: Discussionmentioning

confidence: 63%

“…Soussi et al in 2016 reported 91% in-hospital mortality rate in 11 burn patients receiving ECMO therapy, suggesting that ECMO treatment for burn patients is not advisable [3]. However, in the last few years, several observational studies have revealed favourable outcomes from the use of ECMO [23,[25][26][27][28][29][30][31]. In this study, our meta-analysis revealed a pooled SMR of 2.07, suggesting a two-fold higher mortality rate compared to the predicted mortality in patients receiving ECMO therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the insu cient patient numbers from the available literature, along with limited evidence, the role of ECMO in patients with burn and inhalation injuries is unclear [2]. In recent years, several case series and retrospective studies have been performed, but the ndings still vary [3,[22][23][24][25][26][27][28][29][30][31][32]. Randomised controlled trials of ECMO compared to conventional therapy might be the solution.…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation in Patients with Burns, Hero or Futile Medical Care? A Systematic Review and Meta-Analysis

Chiu¹,

Huang²,

Chen³

et al. 2020

Preprint

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Background Severely burned patients, particularly when compounded with inhalation injuries, are at high risk for cardiopulmonary failure. Recently, promising studies have stimulated interest in using extracorporeal membrane oxygenation (ECMO) as a potential therapy for burn patients with refractory cardiac and/or respiratory failure. Several observational studies have been reported, but the findings in these vary. Methods In this study, we conducted a systematic review and meta-analysis using standardized mortality ratios (SMRs) to elucidate the benefits associated with the use of ECMO in patients with burn and/or inhalation injuries. A literature search using PubMed, EMBASE, MEDLINE, and the Cochrane Library were performed from inception to October 20, 2020. Clinical outcomes in the selected studies were compared. Results 22 studies were included in the final review and analysis. 13 studies with a total of 75 patients were included in SMR quantitative analysis. The overall pooled mortality rate of burn patients receiving ECMO was 48%. The meta-analysis found that the observed mortality was significantly higher than the predicted mortality in patients receiving ECMO, with a pooled SMR of 2.07 (95% CI: 1.04–4.14). However, in the subgroup of burn patients with inhalation injuries, all patients receiving V-V ECMO had lower mortality rates compared to their predicted mortality rates, with a pooled SMR of 0.95 (95% CI: 0.52–1.73). Other subgroup analyses, including an adult group, pediatric group, V-V setting group, and a V-A setting group reported no benefits from ECMO; however, these results were not statistically significant. Interestingly, the pooled SMR values decreased as the selected patients’ revised Baux scores increased (R=-0.92), indicating that the potential benefits from the ECMO treatment increased as the severity of patients with burns increased, especially when the patients’ revised Baux scores exceeded 90. Conclusions Our meta-analysis revealed that burn patients receiving ECMO treatment were at a higher risk of death. However, select patients, including those with inhalation injuries and those with the revised Baux scores over 90, would benefit from ECMO treatment. We suggest that burn patients with inhalation injuries or with revised Baux scores exceeding 90 should be considered for ECMO treatment and early transfer to an ECMO centre.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation in Patients with Burns, Hero or Futile Medical Care? A Systematic Review and Meta-Analysis

Chiu¹,

Huang²,

Chen³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

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“…Smoke is a common toxin that causes acute inhalation injuries and ARDS that requires ECMO support. The cases of ECMO support for fire-induced smoke inhalation injuries (29)(30)(31)(32)(33)(34)(35) and zinc chloride inhalation from smoke bombs have been reported (36). Electronic cigarettes (e-cigarettes) are battery-powered devices that aerosolize various substances for inhalation, such as nicotine, tetrahydrocannabinol, cannabidiol, and flavoring agents that may contain diacetyl.…”

Section: Ecmo For Acute Toxic Inhalationmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Acute Toxic Inhalations: Case Reports and Literature Review

et al. 2021

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Previous studies have shown that poisoning is a major threat to human health. Inhalation of acute toxic gas has been linked to serious health consequences. Among the antidotes for poisoning currently used, supportive care is the most common intervention in clinical practice. Severe acute respiratory distress syndrome (ARDS) and/or refractory cardiogenic shock or cardiac arrest caused by toxins are associated with high mortality and are difficult to treat. Extracorporeal membrane oxygenation (ECMO) is an aggressive supportive measure used to manage severely poisoned patients. This study presents two cases of acute toxic gases inhalation, severe ARDS and circulatory instability induced by bromine inhalation, and ARDS induced by nitric acid inhalation which were successfully treated with ECMO. The ECMO techniques used in the animal models and in human cases to treat severe poisoning are described as well as the indications, contraindications, complications, and weaning of ECMO.

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“…In recent years, blast injuries have become an increasingly serious problem in military and civilian practice and have had a huge impact on all regions of the world. For example, explosion accidents in Tianjin port on August 12, 2015 [ 1 ], and in Taiwan on June 27, 2015 [ 2 , 3 ], were caused by chemical dangerous goods, dust explosions, and gas explosions in factories. These blast injuries not only caused economic damage but also seriously affected people's life.…”

Section: Introductionmentioning

confidence: 99%

Proteomic Analysis Revealed the Characteristics of Key Proteins Involved in the Regulation of Inflammatory Response, Leukocyte Transendothelial Migration, Phagocytosis, and Immune Process during Early Lung Blast Injury

Liu

Tong

Cong

et al. 2021

Oxidative Medicine and Cellular Longevity

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Previous studies found that blast injury caused a significant increased expression of interleukin-1, IL-6, and tumor necrosis factor, a significant decrease in the expression of IL-10, an increase in Evans blue leakage, and a significant increase in inflammatory cell infiltration in the lungs. However, the molecular characteristics of lung injury at different time points after blast exposure have not yet been reported. Therefore, in this study, tandem mass spectrometry (TMT) quantitative proteomics and bioinformatics analysis were used for the first time to gain a deeper understanding of the molecular mechanism of lung blast injury at different time points. Forty-eight male C57BL/6 mice were randomly divided into six groups: control, 12 h, 24 h, 48 h, 72 h, and 1 w after low-intensity blast exposure. TMT quantitative proteomics and bioinformatics analysis were performed to analyze protein expression profiling in the lungs from control and blast-exposed mice, and differential protein expression was verified by Western blotting. The results demonstrated that blast exposure induced severe lung injury, leukocyte infiltration, and the production of inflammatory factors in mice. After analyzing the expression changes in global proteins and inflammation-related proteomes after blast exposure, the results showed that a total of 6861 global proteins and 608 differentially expressed proteins were identified, of which 215, 128, 187, 232, and 65 proteins were identified at 12 h, 24 h, 48 h, 72 h, and 1 week after blast exposure, respectively. Moreover, blast exposure-induced 177 differentially expressed proteins were associated with inflammatory responses, which were enriched in the inflammatory response regulation, leukocyte transendothelial migration, phagocytosis, and immune response. Therefore, blast exposure may induce early inflammatory response of lung tissue by regulating the expression of key proteins in the inflammatory process, suggesting that early inflammatory response may be the initiating factor of lung blast injury. These data can provide potential therapeutic candidates or approaches for the development of future treatment of lung blast injury.

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Extracorporeal membrane oxygenation support may be a lifesaving modality in patients with burn and severe acute respiratory distress syndrome: Experience of Formosa Water Park dust explosion disaster in Taiwan

Cited by 21 publications

References 34 publications

Extracorporeal Membrane Oxygenation in Patients with Burns, Hero or Futile Medical Care? A Systematic Review and Meta-Analysis

Extracorporeal Membrane Oxygenation in Patients with Burns, Hero or Futile Medical Care? A Systematic Review and Meta-Analysis

Extracorporeal Membrane Oxygenation for Acute Toxic Inhalations: Case Reports and Literature Review

Proteomic Analysis Revealed the Characteristics of Key Proteins Involved in the Regulation of Inflammatory Response, Leukocyte Transendothelial Migration, Phagocytosis, and Immune Process during Early Lung Blast Injury

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