Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury

Muellenbach, Ralf Michael; Kredel, Markus; Kunze, Ekkehard; Kranke, Peter; Kuestermann, Julian; Brack, Alexander; Gorski, Armin; Wunder, Christian; Roewer, Norbert; Wurmb, Thomas

doi:10.1097/ta.0b013e31824d68e3

Cited by 178 publications

(141 citation statements)

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“…A recent case series recommends prolonged heparin-free vv-ECMO therapy in multiple traumatized patients with ALF with coexisting traumatic brain injury and intracranial bleeding. Neither ECMO-associated bleeding nor clotting of the extracorporeal circuit occurred and all three patients survived [24]. …”

Section: Discussionmentioning

confidence: 99%

Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

Ried¹,

et al. 2013

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IntroductionSevere trauma with concomitant chest injury is frequently associated with acute lung failure (ALF). This report summarizes our experience with extracorporeal lung support (ELS) in thoracic trauma patients treated at the University Medical Center Regensburg.MethodsA retrospective, observational analysis of prospectively collected data (Regensburg ECMO Registry database) was performed for all consecutive trauma patients with acute pulmonary failure requiring ELS during a 10-year interval.ResultsBetween April 2002 and April 2012, 52 patients (49 male, three female) with severe thoracic trauma and ALF refractory to conventional therapy required ELS. The mean age was 32 ± 14 years (range, 16 to 72 years). Major traffic accident (73%) was the most common trauma, followed by blast injury (17%), deep fall (8%) and blunt trauma (2%). The mean Injury Severity Score was 58.9 ± 10.5, the mean lung injury score was 3.3 ± 0.6 and the Sequential Organ Failure Assessment score was 10.5 ± 3. Twenty-six patients required pumpless extracorporeal lung assist (PECLA) and 26 patients required veno-venous extracorporeal membrane oxygenation (vv-ECMO) for primary post-traumatic respiratory failure. The mean time to ELS support was 5.2 ± 7.7 days (range, <24 hours to 38 days) and the mean ELS duration was 6.9 ± 3.6 days (range, <24 hours to 19 days). In 24 cases (48%) ELS implantation was performed in an external facility, and cannulation was done percutaneously by Seldinger's technique in 98% of patients. Cannula-related complications occurred in 15% of patients (PECLA, 19% (n = 5); vv-ECMO, 12% (n = 3)). Surgery was performed in 44 patients, with 16 patients under ELS prevention. Eight patients (15%) died during ELS support and three patients (6%) died after ELS weaning. The overall survival rate was 79% compared with the proposed Injury Severity Score-related mortality (59%).ConclusionPumpless and pump-driven ELS systems are an excellent treatment option in severe thoracic trauma patients with ALF and facilitate survival in an experienced trauma center with an interdisciplinary treatment approach. We encourage the use of vv-ECMO due to reduced complication rates, better oxygenation and best short-term outcome.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

Ried¹,

et al. 2013

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“… Combined injury besides pulmonary failure Intervention ECMO Heparin ECMO duration Outcome Madershahian et al [2]1, 19/FSpleen, LiverLaparotomyv-a 5 (+)138 hoursSurvivedRight main bronchusThoracotomy2, 48/MVertebra and long bone FractureOsteosynthesisv-a(+)120 hoursSurvived3, 26/MSpleenSplenectomyv-va 6 (+)84 hoursSurvivedBrainYuan et al [5]4, 18/MLiver, Gr. IIIConservativev-v(+)10 daysSurvivedEndobronchial hemorrhage5, 38/MBrain SDH 1 Conservativev-v(+)5 daysSurvivedCampione et al [4]6, 14/MBronchial DisruptionRight bilobectomy of lungv-v(+)3 daysSurvivedYen et al [7]7, 21/MBrain EDH 2 Decompressive craniotomyv-a(+)49 hoursSurvivedFriesenecker, et al [8]8, 34/MLiver, SpleenLaparotomyv-v(+)17 daysSurvivedBrain ICH 3 with edemaDecompressive craniotomyMuellenbach et al [9]9, 53/MLiverLaparotomyv-v(−)8 daysSurvivedTraumatic brain injuryICP 4 Monitoring10, 16/MTraumatic brain injuryv-v(−)3 daysSurvived11, 28/MSpleenSplenectomyv-v(−)2 daysSurvivedTraumatic brain injury...…”

Section: Literature Reviewmentioning

confidence: 99%

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

et al. 2015

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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.

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“…Une anticoagulation systé mique est donc né cessaire pour inhiber l'activation de la thrombine malgré les progrè s ré alisé s au niveau du maté riel d'ECMO avec l'impré gnation des tuyaux par de l'hé parine qui ré duit la ré ponse inflammatoire et diminue l'activation du systè me de coagulation [10,11]. En situation d'hé morragie, un arrêt temporaire de l'hé parine est possible et des cas d'arrêt prolongé de l'anticoagulation chez des patients sous ECMO sans é vè nement thrombotique sont dé crits [12], grâce à la pré hé parinisation des circuits.…”

Section: Discussionunclassified

Utilisation du facteur VIIa en cas d’hémorragie réfractaire sous ECMO centrale veino-artérielle

Vanhuyse¹,

Frotscher²,

Lecompte³

et al. 2013

Annales Françaises d'Anesthésie et de Réanimation

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Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury

Abstract: IV, therapeutic study.

Cited by 178 publications

References 13 publications

Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

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

Utilisation du facteur VIIa en cas d’hémorragie réfractaire sous ECMO centrale veino-artérielle

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