The use of extracorporeal membrane oxygenation in trauma patients

Abstract

Extracorporeal membrane oxygenation (ECMO) has been increasingly applied for the treatment of patients with trauma. Because a common complication of ECMO is bleeding, the use of ECMO support for patients with trauma was limited in the past. Studies have demonstrated a survival benefit from ECMO support in cases of traumatic lung injury, and it is likely that patients with other types of trauma would also benefit from ECMO support. However, the effect of ECMO in patients with other types of trauma is unknown.Using the national insurance data of Taiwan, we identified 810 patients with trauma who received ECMO support from 2000 to 2010. Patients who died or who withdrew from the program within 7 days after discharge were defined as deceased. Logistic regression was used to estimate the odds ratio (OR) of death and 95% confidence intervals (CIs).The overall mortality was 32.8% (266/810). A total of 417 patients received surgery during hospitalization, with an overall mortality of 39.0% (163/417). Patients who underwent thoracic surgery had an OR of 2.23 (95% CI: 1.49–3.34) compared with those who did not. Patients who underwent brain surgery had an OR of 2.86 (95% CI: 1.37–5.98) compared with patients who did not. Patients who received abdominal surgery had an OR of 4.47 (95% CI: 2.63–7.61) compared with patients who did not. All types of surgery had odds of mortality except orthopedic surgery; the use of ECMO with orthopedic surgery had an OR of 1.06 (95% CI: 0.69–1.62) compared with patients who did not receive orthopedic surgery.Except for orthopedic surgery, patients with trauma who received ECMO support and required further surgery during hospitalization exhibited a relatively high mortality rate.

Traumatic injury pattern is of equal relevance as injury severity for experimental (poly)trauma modeling

“…Yet, this is a critical issue in all currently available polytrauma models. Of course, since ECMO therapy is increasingly applied for the treatment of patients with trauma 55 , its in vivo use is indicated for better improvement of the translational interpretation. However, since there are common complications of ECMO limiting its use in patients with trauma 55 , this strategy has to be considered carefully.…”

“…Of course, since ECMO therapy is increasingly applied for the treatment of patients with trauma 55 , its in vivo use is indicated for better improvement of the translational interpretation. However, since there are common complications of ECMO limiting its use in patients with trauma 55 , this strategy has to be considered carefully. Furthermore, ECMO often triggers systemic inflammation, which should be considered if the inflammatory response to polytrauma will be analyzed 56 .…”

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

“…The use of ECMO in the early phase should be kept in mind and has been described recently in the literature . Although the clinical cases presented here may seem promising, it should be remembered that trauma patients receiving ECMO support and requiring additional surgery during their hospitalization have an increased mortality rate …”

“…However, because of the risk of bleeding, the use of vv‐ECMO on multitrauma patients to help perform surgery is still rare and is rarely reported in the literature. A recently published Taiwanese case‐control study reported that trauma patients receiving ECMO support had an increased mortality rate and that they required further surgery during their hospitalization …”

Extra Corporeal Life Support in Traumatic Brain Injury Patients

“…Some authors [23] (recently proposed the application of heparin-free ECMO, showing good outcomes and no complications. Chen et al [47] used VV ECMO without anticoagulation in 7 polytraumatic patients without any haemorrhagic complications. Other authors proposed the use of half dose of heparin, with the use of heparin-bonded circuits, which allow systemic heparin dose to be decreased by half, from 4 mg/Kg to 1.5 mg/Kg [48].…”