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

Lang, Nikolaus; Schwihla, Ines; Weihs, Valerie; Kasparek, Michael S.; Joestl, Julian; Hajdu, Stefan; Sarahrudi, Kambiz

doi:10.1038/s41598-019-49346-z

Cited by 15 publications

(18 citation statements)

References 23 publications

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“…3,4 There is a paucity of data reporting on the use of venoarterial (VA) ECMO in trauma, which is more technically demanding and adds the component of managing cardiac failure and respiratory failure, in a sicker patient population at baseline. 7,8 One group from Austria reported on 18 patients with traumatic cardiopulmonary failure with ECLS, 6 demonstrating a trend toward better survival with earlier cannulation (albeit in less severely injured patients based on the ISS). Most patients in that study did not present with cardiac arrest but instead presented with refractory shock or respiratory failure as clinical indications for ECMO.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation May Improve Outcomes After Resuscitative Thoracotomy: A National Trauma Data Bank Analysis

Owattanapanich

Inaba

Allen

et al. 2021

The American Surgeon™

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Background Albeit low survival rates, resuscitative thoracotomy (RT) is considered standard for selected trauma patients. Because it has potential for rapid cardiopulmonary rescue, extracorporeal membrane oxygenation (ECMO) may augment RT. The aim of this study was to identify the impact of ECMO on trauma patients that recently underwent RT after injury. Study Design All patients who underwent RT were identified from the National Trauma Data Bank (2007-2017). Patients were excluded if they died within 60 minutes, underwent delayed ECMO, and/or had missing data. Delayed ECMO group was defined as those patients undergoing ECMO after 1 hour following RT. Results Out of 8 694 272 injured patients, 10 106 (.1%) underwent RT. Median age was 31 years [23-45], 86% male. Penetrating injury was the dominant mechanism (62%). Of these, .6% (23) underwent immediate ECMO. Extracorporeal membrane oxygenation patients were significantly younger (23[17-33] vs. 31[23-46], p .003) and had significantly higher chest abbreviated injury scale scores (5[4-5] vs. 3[3-4], P < .001). Extracorporeal membrane oxygenation patients achieved significantly higher rate of return of spontaneous circulation (96% vs. 70%, p .007) and had nonsignificant trend of improved mortality (52% vs. 63%, p .260). Conclusion Immediate ECMO may be a useful therapeutic modality after RT. It achieves higher ROSC rates with opportunity for improved survival. Future prospective study is warranted.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation May Improve Outcomes After Resuscitative Thoracotomy: A National Trauma Data Bank Analysis

Owattanapanich

Inaba

Allen

et al. 2021

The American Surgeon™

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“…One recent systematic review combining 215 trauma patients supported with ECMO reported a survival-to-discharge rate ranging from 56 to 89% after VV ECMO and 42 to 63% after VA ECMO [3]. In the study reported by Lang et al [11], VA ECMO was applied in 15 cases, and 11 patients (73%) died. However, limited studies have examined outcomes for VA ECMO in trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation in trauma patients: a systematic review

et al. 2020

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Background Extracorporeal membrane oxygenation (ECMO) has evolved considerably over the past two decades and has been gradually utilized in severe trauma. However, the indications for the use of ECMO in trauma remain uncertain and the clinical outcomes are different. We performed a systematic review to provide an overall estimate of the current performance of ECMO in the treatment of trauma patients. Materials and methods We searched PubMed and MEDLINE databases up to the end of December 2019 for studies on ECMO in trauma. The PRISMA statement was followed. Data on demographics of the patient, mechanism of injury, injury severity scores (ISS), details of ECMO strategies, and clinical outcome were extracted. Results A total of 58 articles (19 retrospective reports and 39 case reports) were deemed eligible and included. In total, 548 patients received ECMO treatment for severe trauma (adult 517; children 31; mean age of adults 34.9 ± 12.3 years). Blunt trauma (85.4%) was the primary injury mechanism, and 128 patients had traumatic brain injury (TBI). The mean ISS was 38.1 ± 15.0. A total of 71.3% of patients were initially treated with VV ECMO, and 24.5% were placed on VA ECMO. The median time on ECMO was 9.6 days, and the median time to ECMO was 5.7 days. A total of 60% of patients received initially heparin anticoagulation. Bleeding (22.9%) and thrombosis (19%) were the most common complications. Ischemia of the lower extremities occurred in 9 patients. The overall hospital mortality was 30.3%. Conclusions ECMO has been gradually utilized in a lifesaving capacity in severe trauma patients, and the feasibility and advantages of this technique are becoming widely accepted. The safety and effectiveness of ECMO in trauma require further study. Several problems with ECMO in trauma, including the role of VA-ECMO, the time to institute ECMO, and the anticoagulation strategy remain controversial and must be solved in future studies.

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“…Complex airway surgery with central bronchial reconstruction, surgery in central tumors with heart invasion or in high-risk patients in whom single lung ventilation is not enough to perform the proposed resection, several forms of EMCS might be used in order to accomplish with safety the proposed surgery. In rare situations of thoracic trauma, EMCS can be helpful (4). This paper will address several modalities of EMCS, their cannulation strategies and their rationale for intraoperative support during general thoracic surgery.…”

Section: Review Articlementioning

confidence: 99%

Cannulation strategies for intraoperative mechanical cardio-respiratory support in general thoracic surgery

Silva¹,

Santos²,

Calvinho³

et al. 2023

Curr Chall Thorac Surg

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In general thoracic surgery, extracorporeal mechanical cardio-respiratory support (EMCS) techniques are performed intraoperatively mainly for respiratory but also for cardiocirculatory support. The increasing panel of EMCS technologies available in thoracic surgery is the result of a century of clinical practices, engineering progress, and improvements of physiological knowledge. Complex procedures of tumor resection, traqueal and main airway surgery or lung transplantation are the scenarios where these techniques should be considered if needed. The aim of this review is to describe different modalities of EMCS used in general thoracic surgery with a particular attention to the cannulation techniques. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is the most common EMCS modality and represents the most efficient in supporting lung function. Venoarterial ECMO (VA-ECMO) may be achieved in both central and peripheral cannulation. Central VA-ECMO is the main modality for intraoperative emergent support, which brought a decrease in popularity of classic cardiopulmonary bypass (CPB) due to lower risk of complications. Peripheral VA-ECMO is traditionally performed in a femorofemoral configuration. Extracorporeal CO 2 removal (ECCO 2 R) and Novalung are marginal alternatives for intraoperative support during general thoracic surgery. Although rarely used, ECMS techniques should be part of every general thoracic surgeon armamentarium and should be brought to mind in complex cases or in emergency settings.

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

Cited by 15 publications

References 23 publications

Extracorporeal Membrane Oxygenation May Improve Outcomes After Resuscitative Thoracotomy: A National Trauma Data Bank Analysis

Extracorporeal Membrane Oxygenation May Improve Outcomes After Resuscitative Thoracotomy: A National Trauma Data Bank Analysis

Extracorporeal membrane oxygenation in trauma patients: a systematic review

Cannulation strategies for intraoperative mechanical cardio-respiratory support in general thoracic surgery

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