Venovenous extracorporeal life support for posttraumatic respiratory distress syndrome in adults: the risk of major hemorrhages

Wu, Meng-Yu; Lin, Pyng-Jing; Tseng, Yuan-His; Kao, Kuo‐Chin; Hsiao, Hsuan-Ling; Huang, Chung-Chi

doi:10.1186/s13049-014-0056-0

Cited by 38 publications

(41 citation statements)

References 22 publications

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“…The authors did not have significant differences in bleeding between coagulated and non-anticoagulated patients, however the median injury-to ECMO time was 6 days, longer than in some other studies [26]. This might be explained because the acute coagulopathy phase is mainly during the first 24 hours from trauma [49,50]. However, there is lack of consensus among the studies about when to start anticoagulation, or in which situations is better to avoid any anticoagulation, therefore the decision is individualised in each centre [49,51].…”

Section: Complications Of Extra Corporeal Therapy Bleeding and Anticmentioning

confidence: 70%

Extra Corporeal Life Support in Traumatic Brain Injury Patients

López¹,

Torre²,

Bilotta³

et al. 2019

obm neurobiol

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Purpose of review: The purpose of this review is to describe recent evidence regarding the use of Extracorporeal Membrane Oxygenation (ECMO) as rescue therapy for refractory cardiac or respiratory failure in patients with traumatic brain injury (TBI) when conventional treatments have failed. The characteristics of these patients, including the risk of bleeding and developing malignant intracranial hypertension, are generally considered as relative contraindications to ECMO treatment; however, recent evidence suggests that the use of ECMO should be considered even in this cohort. Recent findings: Recent findings suggest that venous-venous (V-V) ECMO can be feasible in the treatment of severe acute respiratory distress syndrome (ARDS) TBI-related. Venousarterial (V-A) ECMO has emerged as a salvage intervention in TBI patients complicated with cardiogenic shock and after cardiac arrest. Improvement of ECMO techniques, including the introduction of centrifugal pumps and heparin-coated circuits, are progressively reducing the amount of heparin required. Moreover, the application of low dose heparin or heparinfree protocols anticoagulation in ECMO has shown good outcome and minimal bleeding and thrombotic complications. Summary: ECMO can be considered as a safe and feasible rescue therapy even in TBI patients. However, there is a lack of evidence. Further studies are warranted, focusing on brain trauma patients undergoing ECMO to better clarify the effect on survival, the type and dose of anticoagulation, and the utility of dedicated multidisciplinary trauma-ECMO units.

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Section: Complications Of Extra Corporeal Therapy Bleeding and Anticmentioning

confidence: 70%

Extra Corporeal Life Support in Traumatic Brain Injury Patients

López¹,

Torre²,

Bilotta³

et al. 2019

obm neurobiol

View full text Add to dashboard Cite

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“…It was noted that the double lumen cannula utilized was not heparin coated and thus heparin dosages had to be adjusted to maintain the prothrombin time (PTT) in the range of 50-60. As such, this approach in patients [45,112].…”

Section: Extracorporeal Membrane Oxygenation: Advances In Therapymentioning

confidence: 97%

“…Even when systemic heparinization is required during active ECMO therapy, mortality figures continue to be better than those for comparable non-ECMO trauma patients with equivalent injury severity [45]. In one study, 67.8% of trauma patients receiving ECMO with systemic heparinization survived [45]-a number comparable to non-heparinized trauma patients [46]. Later in the chapter, we discuss the application of ECMO without the use of anticoagulation, including important preconditions, indications, contraindications, and risks associated with such approaches.…”

Section: Ecmo: a Synopsismentioning

confidence: 99%

“…Finally, financial aspects of ECMO therapy must be recognized as well, with significant barriers to wider implementation due to healthcare institutions being increasingly focused on cost containment and value [26][27][28]. [33], Bonacchi et al [110], Muellenbach et al [89], Ried et al [111], Wu et al [45].…”

Section: Ecmo: a Synopsismentioning

confidence: 99%

“…However, since then, ECMO circuits have evolved into essentially portable pump-driven devices that are compact, easy to transport, and carry a much lower risk of circuit clotting due to the synergies between device miniaturization, optimization of flow rates, and heparin-bonded circuits that are more biocompatible [29,33]. Even when systemic heparinization is required during active ECMO therapy, mortality figures continue to be better than those for comparable non-ECMO trauma patients with equivalent injury severity [45]. In one study, 67.8% of trauma patients receiving ECMO with systemic heparinization survived [45]-a number comparable to non-heparinized trauma patients [46].…”

Section: Ecmo: a Synopsismentioning

confidence: 99%

See 2 more Smart Citations

Extracorporeal Membrane Oxygenation in Traumatic Injury: An Overview of Utility and Indications

Hughes¹,

Cipolla²,

Thomas³

et al. 2016

Extracorporeal Membrane Oxygenation: Advances in Therapy

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Severe respiratory failure may develop in the trauma patient as a consequence of direct lung injury, in response to trauma-associated systemic inflammatory response syndrome SIRS , as a result of infection, or at times as an unintended consequence of the life-saving management of the acute traumatic injury. "pproximately . % of all adult trauma patients develop some form of pulmonary dysfunction along the acute lung injury "LI acute respiratory distress "RDS spectrum, with the incidence of severe respiratory failure reaching % in multisystem trauma victims. Of concern, mortality in patients with acute respiratory failure who go on to develop severe pulmonary dysfunction can be as high as % with the use of conventional therapeutic modalities. Extracorporeal membrane oxygenation ECMO has been proposed as a rescue strategy when less invasive primary or adjunctive attempts fail. Numerous case reports and single-center studies demonstrate potential benefits of early implementation of veno-venous VV -ECMO for the treatment of severe respiratory failure associated with trauma or sequelae of trauma. In this clinical context, VV-ECMO can be employed to correct for both ventilatory and oxygenation failure while allowing the treating physician to provide much needed rest to the patient's lungs and permit healing to take place. The use of ECMO mainly veno-venous, with limited use of veno-arterial circuits for cardiac indications has been described in patients with severe chest injuries, traumatic pneumonectomy, bronchopleural fistulas, and various forms of respiratory failure refractory to conventional therapies.

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