Extracorporeal life support in patients with multiple injuries and severe respiratory failure: A single-center experience?

被引:54
作者
Biderman, Philippe [1 ]
Einav, Sharon [4 ]
Fainblut, Michael [1 ]
Stein, Michael [2 ]
Singer, Pierre [3 ]
Medalion, Benjamin [1 ]
机构
[1] Tel Aviv Univ, Rabin Med Ctr, Dept Cardiothorac Surg, IL-69978 Tel Aviv, Israel
[2] Tel Aviv Univ, Rabin Med Ctr, Trauma Unit, IL-69978 Tel Aviv, Israel
[3] Tel Aviv Univ, Rabin Med Ctr, Dept Gen Intens Care, IL-69978 Tel Aviv, Israel
[4] Hebrew Univ Jerusalem, Shaare Zedek Med Ctr, Gen Intens Care Unit, Jerusalem, Israel
关键词
Extracorporeal membrane oxygenation; adult respiratory distress syndrome; multiple trauma; traumatic brain injury; MEMBRANE-OXYGENATION; LUNG ASSIST; PROFOUND HYPOTHERMIA; SUSPENDED ANIMATION; SWINE MODEL; INDUCTION; REVERSAL; ARREST; BLOOD; TRIAL;
D O I
10.1097/TA.0b013e3182a8334f
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: The use of extracorporeal life support in trauma casualties is limited by concerns regarding hemorrhage, particularly in the presence of traumatic brain injury (TBI). We report the use of extracorporeal membrane oxygenation (ECMO)/interventional lung assist (iLA) as salvage therapy in trauma patients. High-flow technique without anticoagulation was used in patients with coagulopathy or TBI. METHODS: Data were collected from all adult trauma patients referred to one center for ECMO/iLA treatment owing to severe hypoxemic respiratory failure. RESULTS: Ten casualties had a mean (SD) Injury Severity Score (ISS) of 50.3 (10.5) (mean [SD] age, 29.8 [7.7] years; 60% male) and were supported 9.5 (4.5) days on ECMO (n = 5) and 7.6 (6.5) days on iLA (n = 5). All experienced blunt injury with severe chest injuries, including one cardiac perforation. Most were coagulopathic before initiation of ECMO/iLA support. Among the seven patients with TBI, four had active intracranial hemorrhage. Complications directly related to support therapy were not lethal; these included hemorrhage from a cannulation site (n = 1), accidental removal of a cannula (n = 1), and pressure sores (n = 3). Deaths occurred owing to septic (n = 2) and cardiogenic shock (n = 1). Survival rates were 60% and 80% on ECMO and iLA, respectively. Follow-up of survivors detected no neurologic deterioration. CONCLUSION: ECMO/iLA therapy can be used as a rescue therapy in adult trauma patients with severe hypoxemic respiratory failure, even in the presence of coagulopathy and/or brain injury. The benefits of rewarming, acid-base correction, oxygenation, and circulatory support must be weighed individually against the risk of hemorrhage. Further research should determine whether ECMO therapy also confers survival benefit. (J Trauma Acute Care Surg. 2013;75:907-912. Copyright (C) 2013 by Lippincott Williams & Wilkins)
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收藏
页码:907 / 912
页数:6
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