Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review

Abstract

Pulmonary contusion and acute respiratory distress syndrome (ARDS) is a common manifestation in polytraumatic patients. Although mechanical ventilation is still the first choice of treatment, a group of patients are still unable to maintain their oxygenation. The role of extracorporeal membrane oxygenation (ECMO) has been more clarified when the lung is extensively damaged and when conventional modality failed. ECMO provides the lung an opportunity to rest by permitting reduced ventilator settings and limiting further barotraumas. However, ECMO is still considered contraindicated in polytramatic patients combining pulmonary contusion and other organ hemorrhage because of systemic anticoagulation during the treatment. We herein report a patient who successfully survive a multitrauma combining pulmonary contusion and grade IV liver laceration using non-heparinized venovenous extracorporeal membrane oxygenation (vv-ECMO). The associated literature were reviewed.

Pulmonary lobectomy in two multitrauma patients under extracorporeal circulation placed preoperatively in an intensive care unit: A case report

“…The use of nonheparinized vv‐ECMO in multitrauma patients suffering from ARDS is being developed because the risk of bleeding remains challenging in trauma patients. The application of nonheparinized vv‐ECMO to perform thoracic surgery has not yet been described.…”

Extrakorporale Membranoxygenierung in der Thoraxchirurgie: die Sicht des Anästhesisten

“…Bei der perioperativen vvECMO verzichten die Autoren auf den initialen Bolus und eine sofortige kontinuierliche Antikoagulation, um das intraoperative Blutungsrisiko zu minimieren. Diese Praxis wird durch die Heparinbeschichtung der ECMO-Schlauchsysteme ermöglicht und basiert auf Fallbeschreibungen [31][32][33][34]. Postoperativ wird die Antikoagulation mit einer Ziel-aPTT von 50 s begonnen, was entgegen den ELSO-Empfehlungen bei einer vvECMO allgemein als ausreichend angesehen wird.…”

Medication Complications in Extracorporeal Membrane Oxygenation

“…49,50 Furthermore, heparin-free ECMO may be a consideration in select ECMO patients with severe trauma or extensive bleeding risks. 51,52 The use of UFH as well as specific titration endpoints should be tailored to each patient's individualized thrombotic and hemorrhagic risk factors.…”