Venovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure

Abstract

Therapeutic study, level III.

Complications During Extracorporeal Membrane Oxygenation

“…For example, DIC during extracorporeal support cannot be defined using validated scores such as the DIC score of the International Society on Thrombosis and Haemostasis (2). In the absence of ECMO-specific, validated scores, DIC is therefore defined variably or reported without a clear definition, e.g., a composite of thrombocytopenia unresponsive to transfusion, prolonged activated clotting time despite lower heparin infusion rates, prothrombin time higher than three times normal, and evidence of clinical bleeding from surgical and/or other sites, vs d-dimer >10,000 units/L and fibrinogen <150 mg/dL, vs no definition provided (3–6). Similarly variable definitions are used for hemorrhagic complications (6–9).…”

Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know

“…ECMO is increasingly used in trauma patients to support gas exchange while maintaining ventilation strategies that minimize or avoid further lung injury from high ventilator pressure and biotrauma from high fraction of inspired oxygen [15,17,27]. The potential for exacerbation of acute lung injury as a result of baro-and biotrauma from ventilator trials has shifted focus on using ECMO to promote lung rest earlier in the patient's course when lung injury is potentially reversible [4,5,14,17,23,[33][34][35][36]54].…”

“…Vascular complications including ischemia and vessel perforation are uncommon with careful monitoring, especially with vvECMO [39]. These are typically minor and can usually be treated conservatively [4,5,14,36,40]. Evidence of Bfree floatingt hrombus at the cannula tip may necessitate placement of an IVC filter [1].…”

“…Recent advances in the biocompatibility of polymethylpentene gas exchange membranes, tipto-tip heparin bonding, and increased portability of miniaturized battery operated stand-alone systems have decreased the risk of clotting in the circuit, membrane-related hemolysis, and hemodilution from large priming volumes [4,5,[14][15][16][17][18][19][20]. High-flow vvECMO can now be used successfully without heparinization or restriction of blood coagulation support under careful monitoring with few thromboembolic complications [5,14,19,[21][22][23][24][25][26].…”

“…Early aggressive use of ECMO in trauma can reverse the vicious cycle of metabolic acidosis, hypothermia, and coagulopathy leading to multi-organ system failure [4,[29][30][31][32][33]. Patients have traditionally been started on ECMO as a salvage therapy when trials with all other therapeutic modalities have failed [5,14,21,34], however, with the decreased dependence on anticoagulation, early implementation is increasingly being called for in the trauma surgery literature for patients with traumatic injuries or trauma-related sequelae associated with low survivability, especially for injuries involving the chest [5,14,15,17,22,24,35]. With improved resuscitation techniques and increased portability of new ECMO devices, more patients can be safely transported to the CT suite.…”