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Lu S, Sun Y, Chen Y, Fu Y, Li J, Liu C. Utilization of ECMO with fiberoptic bronchoscopy for pediatric patients with lethal pulmonary hemorrhage unresponsive to conventional mechanical ventilation. Front Pediatr 2025; 13:1547579. [PMID: 40115320 PMCID: PMC11922937 DOI: 10.3389/fped.2025.1547579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 02/17/2025] [Indexed: 03/23/2025] Open
Abstract
Objective To evaluate the safety and efficacy of extracorporeal membrane oxygenation (ECMO) combined with fiberoptic bronchoscopy in children with life-threatening pulmonary hemorrhage that does not respond to conventional mechanical ventilation. Methods From October 2019 to June 2022, four pediatric patients with life-threatening pulmonary hemorrhage requiring ECMO support were admitted to our hospital. Based on their weight and vascular conditions, either venoarterial (VA)-ECMO or venovenous (VV)-ECMO was selected. The anticoagulation strategy was tailored, and fiberoptic bronchoscopy was performed to assess airway bleeding and remove blood clots. Results The study involved four patients. Case 1 sustained injuries from a traffic accident, Case 2 experienced combined injuries from a high fall, Case 3 had pulmonary vascular malformation, and Case 4 presented with anti-neutrophil cytoplasmic antibody-associated vasculitis. Case 1 underwent VA-ECMO with carotid artery and vein cannulation, whereas the other patients received VV-ECMO with jugular-femoral vein cannulation. During cannulation, heparin was administered at 0.5 mg/kg. Protamine was subsequently used to neutralize heparin based on the bleeding situation. Anticoagulation was initiated 24 h after ECMO commencement in Cases 1, 2, and 4, maintaining an activated clotting time (ACT) of 160-180 s. In Case 3, active bleeding was observed in the tracheal tube post-ECMO initiation. Protamine was administered to reverse the effects of heparin, and anticoagulation was withheld for the first 72 h. After a second interventional embolization of the vascular malformations, the active bleeding ceased. Two fiberoptic bronchoscopies revealed no further bleeding, and anticoagulation was initiated at 5 U/kg/h to maintain an ACT of 160 s. Coagulation parameters, including ACT, blood analysis, and thromboelastography, were closely monitored, and heparin dosages were adjusted accordingly. Heparin was paused 1 h before each fiberoptic bronchoscopy and resumed afterward. During ECMO, all patients successfully underwent fiberoptic bronchoscopy. Cases 2 and 3 required three and six procedures, respectively. Substantial thrombi were removed from the airways of Cases 2 and 3. All patients survived, and they were discharged without complications related to ECMO or fiberoptic bronchoscopy. Conclusion For children with life-threatening pulmonary hemorrhage that did not respond to conventional mechanical ventilation, the combination of ECMO and fiberoptic bronchoscopy represents a promising therapeutic option. ECMO rapidly corrects hypoxemia and provides respiratory support, whereas fiberoptic bronchoscopy effectively clears blood clots and facilitates lung re-expansion. Under an individualized anticoagulation strategy, this combined approach is both safe and effective, significantly improving clinical outcomes in pediatric patients with life-threatening pulmonary hemorrhage.
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Affiliation(s)
- Siwei Lu
- Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuelin Sun
- Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yingfu Chen
- Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yueqiang Fu
- Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Li
- Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chengjun Liu
- Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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Ahlqvist M, Forsman P, Morberg P, Larsson M, Broman LM, Akram S. Extracorporeal membrane oxygenation in trauma: a single-center retrospective observational study. Eur J Trauma Emerg Surg 2025; 51:88. [PMID: 39870889 PMCID: PMC11772380 DOI: 10.1007/s00068-024-02734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 09/14/2024] [Indexed: 01/29/2025]
Abstract
PURPOSE Globally, trauma is a leading cause of death in young adults. The use of extracorporeal membrane oxygenation (ECMO) in the trauma population remains controversial due to the limited published research. This study aimed to analyze 30-day survival of all the trauma ECMO patients at our center, with respect to injury severity score (ISS) and new injury severity score (NISS). METHODS We performed a retrospective analysis of all trauma patients receiving ECMO support at a Level 1 trauma center in Sweden between 1997 and 2019. RESULTS A total of 53 trauma patients received ECMO support. 85% were male; the median age was 24, with interquartile range (IQR) 17-44 years. More than 70% were multi-trauma patients. The mean NISS and ISS were 50 (IQR:34-57) and 42 (IQR:33-57), respectively. 62% were supported on veno-arterial ECMO with a survival benefit for veno-venous ECMO (75% vs. 36%, respectively (p = 0.01)). There was no association between severity in terms of trauma-score and survival. Sixteen patients (30%) were cannulated at referring hospitals and transported to our unit on ECMO with a survival of 69%, similar to those cannulated in-house. 60% of patients survived ECMO, and 51% survived to hospital discharge. CONCLUSIONS This study indicates that trauma patients may benefit from ECMO, independent of severity. Furthermore, our results support ECMO transport as feasible in trauma patients. We recommend larger multi-center studies to determine which trauma patients would have the greatest benefit of ECMO.
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Affiliation(s)
- Mathias Ahlqvist
- ECMO Center Karolinska, Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Akademiska straket 14, Stockholm, 17176, Sweden.
- Department of Research and Development, Capio Saint Göran Hospital, Stockholm, Sweden.
| | - Pär Forsman
- ECMO Center Karolinska, Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Akademiska straket 14, Stockholm, 17176, Sweden
| | - Pål Morberg
- Department of Anaesthesia, Vestfold Hospital Trust, Tønsberg, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Magnus Larsson
- ECMO Center Karolinska, Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Akademiska straket 14, Stockholm, 17176, Sweden
- Department of Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Mikael Broman
- ECMO Center Karolinska, Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Akademiska straket 14, Stockholm, 17176, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Shahzad Akram
- ECMO Center Karolinska, Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Akademiska straket 14, Stockholm, 17176, Sweden.
- Department of Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, Sweden.
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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Rafaqat W, Luckoski J, Lagazzi E, Abiad M, Panossian V, Nzenwa I, Kaafarani HMA, Hwabejire JO, Renne BC. Extracorporeal membrane oxygenation in severe traumatic brain injury: Is it safe? J Trauma Acute Care Surg 2025; 98:135-144. [PMID: 39238101 DOI: 10.1097/ta.0000000000004421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
BACKGROUND Patients with severe traumatic brain injury (TBI) are at an increased risk of respiratory failure refractory to traditional therapies. The safety of extracorporeal membrane oxygenation (ECMO) in this population remains unclear. We aimed to examine outcomes following ECMO compared with traditional management in severe TBI patients. METHODS We performed a retrospective cohort study using the Trauma Quality Improvement Program (2017-2020). We identified patients 18 years or older with severe TBI (Abbreviated Injury Score head, ≥3) who underwent ECMO or had either in-hospital cardiac or acute respiratory distress syndrome during their hospitalization. The study excluded pPatients who arrived without signs of life, had a prehospital cardiac arrest, had an unsurvivable injury, were transferred out within 48 hours of arrival, or were received as a transfer and died within 12 hours of arrival Patients with missing information regarding in-hospital mortality were also excluded. Outcomes included mortality, in-hospital complications, and intensive care unit length of stay. To account for patient and injury characteristics, we used 1:1 propensity matching. We performed a subgroup analysis among ECMO patients, comparing patients who received anticoagulants with those who did not. RESULTS We identified 10,065 patients, of whom 221 (2.2%) underwent ECMO. In the propensity-matched sample of 134 pairs, there was no difference in mortality. Extracorporeal membrane oxygenation was associated with a higher incidence of cerebrovascular accidents (9% vs. 1%, p = 0.006) and a lower incidence of ventilator-associated pneumonia. In the subgroup analysis of 64 matched pairs, patients receiving anticoagulation had lower mortality, higher unplanned return to the operating room, and longer duration of ventilation and intensive care unit length of stay. CONCLUSION Extracorporeal membrane oxygenation use in severe TBI patients was not associated with higher mortality and should be considered a potential intervention in this patient population. Systemic anticoagulation showed mortality benefit, but further work is required to elucidate the impact on neurological outcomes, and the appropriate dosing and timing of anticoagulation. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Wardah Rafaqat
- From the Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
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Petty K, Daubenspeck D. Rescue ECMO for Isolated Right Ventricular Dysfunction in a Trauma Patient. J Cardiothorac Vasc Anesth 2024; 38:1031-1036. [PMID: 38105124 DOI: 10.1053/j.jvca.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Kyle Petty
- University of Chicago, Department of Anesthesia and Critical Care, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637.
| | - Danisa Daubenspeck
- Assistant Professor of Anesthesia and Critical Care, University of Chicago, Department of Anesthesia and Critical Care, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637.
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Alremeithi R, Tran QK, Quintana MT, Shahamatdar S, Pourmand A. Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers. World J Emerg Med 2024; 15:3-9. [PMID: 38188559 PMCID: PMC10765073 DOI: 10.5847/wjem.j.1920-8642.2023.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/28/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Traumatic cardiac arrest (TCA) is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system. Although there have been advances in treatment modalities, survival rates for TCA patients remain low. This narrative literature review critically examines the indications and effectiveness of current therapeutic approaches in treating TCA. METHODS We performed a literature search in the PubMed and Scopus databases for studies published before December 31, 2022. The search was refined by combining search terms, examining relevant study references, and restricting publications to the English language. Following the search, 943 articles were retrieved, and two independent reviewers conducted a screening process. RESULTS A review of various studies on pre- and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm. There were conflicting results regarding other prognostic factors, such as witnessed arrest, bystander cardiopulmonary resuscitation (CPR), and the use of prehospital or in-hospital epinephrine. Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock. When implemented in the setting of aortic occlusion, emergency thoracotomy and REBOA resulted in comparable mortality rates. Veno-venous extracorporeal life support (V-V ECLS) and veno-arterial extracorporeal life support (V-A ECLS) are viable options for treating respiratory failure and cardiogenic shock, respectively. In the context of traumatic injuries, V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS. CONCLUSION TCA remains a significant challenge for emergency medical services due to its high morbidity and mortality rates. Pre- and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures. Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment efficacy and ameliorate survival outcomes.
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Affiliation(s)
- Rashed Alremeithi
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA
| | - Quincy K. Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
- Program in Trauma, the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore 21201, USA
| | - Megan T. Quintana
- Center for Trauma and Critical Care, Department of Surgery, the George Washington University School of Medicine & Health Sciences, Washington DC 20037, USA
| | - Soroush Shahamatdar
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA
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Lee A, Romano K, Tansley G, Al-Khaboori S, Thiara S, Garraway N, Finlayson G, Kanji HD, Isac G, Ta KL, Sidhu A, Carolan M, Triana E, Summers C, Joos E, Ball CG, Hameed SM. Extracorporeal life support in trauma: Indications and techniques. J Trauma Acute Care Surg 2024; 96:145-155. [PMID: 37822113 DOI: 10.1097/ta.0000000000004043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Clarity about indications and techniques in extracorporeal life support (ECLS) in trauma is essential for timely and effective deployment, and to ensure good stewardship of an important resource. Extracorporeal life support deployments in a tertiary trauma center were reviewed to understand the indications, strategies, and tactics of ECLS in trauma. METHODS The provincial trauma registry was used to identify patients who received ECLS at a Level I trauma center and ECLS organization-accredited site between January 2014 and February 2021. Charts were reviewed for indications, technical factors, and outcomes following ECLS deployment. Based on this data, consensus around indications and techniques for ECLS in trauma was reached and refined by a multidisciplinary team discussion. RESULTS A total of 25 patients underwent ECLS as part of a comprehensive trauma resuscitation strategy. Eighteen patients underwent venovenous ECLS and seven received venoarterial ECLS. Nineteen patients survived the ECLS run, of which 15 survived to discharge. Four patients developed vascular injuries secondary to cannula insertion while four patients developed circuit clots. On multidisciplinary consensus, three broad indications for ECLS and their respective techniques were described: gas exchange for lung injury, extended damage control for severe injuries associated with the lethal triad, and circulatory support for cardiogenic shock or hypothermia. CONCLUSION The three broad indications for ECLS in trauma (gas exchange, extended damage control and circulatory support) require specific advanced planning and standardization of corresponding techniques (cannulation, circuit configuration, anticoagulation, and duration). When appropriately and effectively integrated into the trauma response, ECLS can extend the damage control paradigm to enable the management of complex multisystem injuries. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Alex Lee
- From the Division of General Surgery, Department of Surgery (A.L., G.T., S.A.-K., N.G., E.J., S.M.H.), Division of Critical Care, Department of Medicine (A.L., S.T., N.G., G.F., H.D.K., G.I., M.H.), Department of Anesthesiology and Perioperative Care (A.L., G.F., G.I., M.C.), University of British Columbia; Perfusion Services (K.T., A.S., E.T., C.S.), Vancouver General Hospital, Vancouver, BC; and Division of General Surgery, Department of Surgery (C.G.B.), University of Calgary, Calgary, AB, Canada
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Hynes AM. Letter re: Extracorporeal Membrane Oxygenation: Rescuing the Resuscitative Thoracotomy. Am Surg 2023; 89:6428-6429. [PMID: 34399593 DOI: 10.1177/00031348211041014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Allyson M Hynes
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Zhang Y, Zhang L, Huang X, Ma N, Wang P, Li L, Chen X, Ji X. ECMO in adult patients with severe trauma: a systematic review and meta-analysis. Eur J Med Res 2023; 28:412. [PMID: 37814326 PMCID: PMC10563315 DOI: 10.1186/s40001-023-01390-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Severe trauma can result in cardiorespiratory failure, and when conventional treatment is ineffective, extracorporeal membrane oxygenation (ECMO) can serve as an adjunctive therapy. However, the indications for ECMO in trauma cases are uncertain and clinical outcomes are variable. This study sought to describe the prognosis of adult trauma patients requiring ECMO, aiming to inform clinical decision-making and future research. METHODS A comprehensive search was conducted on Pubmed, Embase, Cochrane, and Scopus databases until March 13, 2023, encompassing relevant studies involving over 5 trauma patients (aged ≥ 16 years) requiring ECMO support. The primary outcome measure was survival until discharge, with secondary measures including length of stay in the ICU and hospital, ECMO duration, and complications during ECMO. Random-effects meta-analyses were conducted to analyze these outcomes. The study quality was assessed using the Joanna Briggs Institute checklist, while the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The meta-analysis comprised 36 observational studies encompassing 1822 patients. The pooled survival rate was 65.9% (95% CI 61.3-70.5%). Specifically, studies focusing on traumatic brain injury (TBI) (16 studies, 383 patients) reported a survival rate of 66.1% (95% CI 55.4-76.2%), while studies non-TBI (15 studies, 262 patients) reported a survival rate of 68.1% (95% CI 56.9-78.5%). No significant difference was observed between these two survival comparisons (p = 0.623). Notably, studies utilizing venoarterial extracorporeal membrane oxygenation (VA ECMO) (15 studies, 39.0%, 95% CI 23.3-55.6%) demonstrated significantly lower survival rates than those using venovenous extracorporeal membrane oxygenation (VV ECMO) (23 studies, 72.3%, 95% CI 63.2-80.7%, p < 0.001). The graded assessment of evidence provided a high degree of certainty regarding the pooled survival. CONCLUSIONS ECMO is now considered beneficial for severely traumatized patients, improving prognosis and serving as a valuable tool in managing trauma-related severe cardiorespiratory failure, haemorrhagic shock, and cardiac arrest.
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Affiliation(s)
- Yangchun Zhang
- Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li Zhang
- Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xihua Huang
- Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Na Ma
- Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Pengcheng Wang
- Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin Li
- Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xufeng Chen
- Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Xueli Ji
- Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Qiu MS, Deng YJ, Yang X, Shao HQ. Cardiac arrest secondary to pulmonary embolism treated with extracorporeal cardiopulmonary resuscitation: Six case reports. World J Clin Cases 2023; 11:4098-4104. [PMID: 37388806 PMCID: PMC10303601 DOI: 10.12998/wjcc.v11.i17.4098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/30/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Massive pulmonary embolism (PE) results in extremely high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide circulatory and oxygenation support and rescue patients with massive PE. However, there are relatively few studies of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with cardiac arrest (CA) secondary to PE. The aim of the present study is to investigate the clinical use of ECPR in conjunction with heparin anticoagulation in patients with CA secondary to PE.
CASE SUMMARY We report the cases of six patients with CA secondary to PE treated with ECPR in the intensive care unit of our hospital between June 2020 and June 2022. All six patients experienced witnessed CA whilst in hospital. They had acute onset of severe respiratory distress, hypoxia, and shock rapidly followed by CA and were immediately given cardiopulmonary resuscitation and adjunctive VA-ECMO therapy. During hospitalization, pulmonary artery computed tomography angiography was performed to confirm the diagnosis of PE. Through anticoagulation management, mechanical ventilation, fluid management, and antibiotic treatment, five patients were successfully weaned from ECMO (83.33%), four patients survived for 30 d after discharge (66.67%), and two patients had good neurological outcomes (33.33%).
CONCLUSION For patients with CA secondary to massive PE, ECPR in conjunction with heparin anticoagulation may improve outcomes.
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Affiliation(s)
- Min-Shan Qiu
- Department of Critical Care Medicine, Dongguan People’s Hospital, Dongguan 523058, Guangdong Province, China
| | - Yong-Jin Deng
- Department of Critical Care Medicine, Dongguan People’s Hospital, Dongguan 523058, Guangdong Province, China
| | - Xue Yang
- Department of Critical Care Medicine, Dongguan People’s Hospital, Dongguan 523058, Guangdong Province, China
| | - Han-Quan Shao
- Department of Critical Care Medicine, Dongguan People’s Hospital, Dongguan 523058, Guangdong Province, China
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Ndubisi N, van Berkel V. Veno-venous extracorporeal membrane oxygenation for the treatment of respiratory compromise. Indian J Thorac Cardiovasc Surg 2023; 39:1-7. [PMID: 36778720 PMCID: PMC9905006 DOI: 10.1007/s12055-022-01467-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/11/2023] Open
Abstract
Extracorporeal membrane oxygenation for the purpose of intervening upon profound cardiovascular or pulmonary compromise has proven to be a worthy intervention. Technological advancements have allowed this mode of therapy to become more effective and widespread. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a commonly used strategy to help manage patients with pulmonary dysfunction refractory to traditional management methods. This review intends to focus upon common indications and the clinical considerations for the institution of VV-ECMO as well as some of its known complications.
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Affiliation(s)
- Nnaemeka Ndubisi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, 201 Abraham Flexnor Way, Suite 1200, Louisville, KY 40202 USA
| | - Victor van Berkel
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, 201 Abraham Flexnor Way, Suite 1200, Louisville, KY 40202 USA
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11
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Extracorporeal Life Support for Trauma. Emerg Med Clin North Am 2023; 41:89-100. [DOI: 10.1016/j.emc.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mader MMD, Lefering R, Westphal M, Maegele M, Czorlich P. Extracorporeal membrane oxygenation in traumatic brain injury - A retrospective, multicenter cohort study. Injury 2023; 54:1271-1277. [PMID: 36621363 DOI: 10.1016/j.injury.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 12/14/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Patients with traumatic brain injury (TBI) regularly require intensive care with prolonged invasive ventilation. Consequently, these patients are at increased risk of pulmonary failure, potentially requiring extracorporeal membrane oxygenation (ECMO). The aim of this work was to provide an overview of ECMO treatment in TBI patients based upon data captured into the TraumaRegister DGU® (TR-DGU). METHODS A retrospective multi-center cohort analysis of patients registered in the TR-DGU was conducted. Adult patients with relevant TBI (AISHead ≥3) who had been treated in German, Austrian, or Swiss level I or II trauma centers using ECMO therapy between 2015 and 2019 were included. A multivariable logistic regression analysis was used to identify risk factors for the need for ECMO treatment. RESULTS 12,247 patients fulfilled the inclusion criteria. The overall rate of ECMO treatment was 1.1% (134 patients). Patients on ECMO had an overall hospital mortality rate of 38% (51/134 patients) while 13% (1523/12,113 patients) of TBI patients without ECMO therapy died. Male gender (p = 0.014), AISChest 3+ (p<0.001), higher Injury Severity Score (p<0.001) and packed red blood cell (pRBC) transfusion (p<0.001) were associated with ECMO treatment. CONCLUSION ECMO therapy is a potentially lifesaving modality for the treatment of moderate-to-severe TBI when combined with severe chest trauma and pulmonary failure. The in-hospital mortality is increased in this high-risk population, but the majority of patients is surviving.
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Affiliation(s)
- Marius Marc-Daniel Mader
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Federal Republic of Germany; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Federal Republic of Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Federal Republic of Germany
| | - Marc Maegele
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Federal Republic of Germany; Department for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Federal Republic of Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Federal Republic of Germany.
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Outcome of post-traumatic acute respiratory distress syndrome in young patients requiring extracorporeal membrane oxygenation (ECMO). Sci Rep 2022; 12:10609. [PMID: 35739167 PMCID: PMC9226058 DOI: 10.1038/s41598-022-14741-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
We aimed to evaluate the outcomes of post-traumatic acute respiratory distress syndrome (ARDS) in young patients with and without Extracorporeal membrane oxygenation (ECMO) support. A retrospective analysis was conducted for trauma patients who developed ARDS at a level I trauma facility between 2014 and 2020. Data were analyzed and compared between ECMO and non-ECMO group. We identified 85 patients with ARDS (22 patients had ECMO support and 63 matched patients managed by the conventional mechanical ventilation; 1:3 matching ratio). The two groups were comparable for age, sex, injury severity score, abbreviated injury score, shock index, SOFA score, and head injury. Kaplan Meier survival analysis showed that the survival in the ECMO group was initially close to that of the non-ECMO, however, during follow-up, the survival rate was better in the ECMO group, but did not reach statistical significance (Log-rank, p = 0.43 and Tarone-Ware, p = 0.37). Multivariable logistic regression analysis showed that acute kidney injury (AKI) (Odds ratio 13.03; 95% CI 3.17–53.54) and brain edema (Odds ratio 4.80; 95% CI 1.10–21.03) were independent predictors of mortality. Sub-analysis showed that in patients with severe Murray Lung Injury (MLI) scores, non-ECMO group had higher mortality than the ECMO group (100% vs 36.8%, p = 0.004). Although ARDS is uncommon in young trauma patients, it has a high mortality. ECMO therapy was used in a quarter of ARDS cases. AKI and brain edema were the predictors of mortality among ARDS patients. ECMO use did not worsen the outcome in trauma patients; however, the survival was better in those who had severe MLI and ECMO support. Further prospective study is needed to define the appropriate selection criteria for the use of ECMO to optimize the outcomes in trauma patients.
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Amos T, Bannon-Murphy H, Yeung M, Gooi J, Marasco S, Udy A, Fitzgerald M. ECMO (extra corporeal membrane oxygenation) in major trauma: A 10 year single centre experience. Injury 2021; 52:2515-2521. [PMID: 33832706 DOI: 10.1016/j.injury.2021.03.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/26/2021] [Indexed: 02/02/2023]
Abstract
Aim To review the indications, complications and outcomes of extracorporeal membrane oxygenation (ECMO) in major trauma patients. Methods Single centre, retrospective, cohort study. Results Over a ten year period, from 13,420 major trauma patients, 11 were identified from our institutional trauma registry as having received ECMO. These patients were predominantly younger (mean 39 +/- 17 years), male (91%) and severely traumatised (median ISS 50, IQR 34 - 54). Veno-venous (VV) ECMO was used predominantly (n = 7, 64%), to treat hypoxic respiratory failure (mean PaO2/FiO2 ratio 69.7 +/- 38.6), secondary to traumatic lung injury. Veno-arterial (VA) ECMO was used less frequently, primarily to treat massive pulmonary embolism following trauma. Major bleeding complications occurred in four patients, however only one patient died from haemorrhage. Heparin free (2/11), delayed (3/11) or low dose heparin (2/11) therapy was frequently utilised. The median time from injury to ECMO initiation was 1 day (IQR 0.5 - 5.5) and median ECMO duration 9 days (IQR 6.5 - 10.5). ECMO was initiated <72 hours in 6 patients, with survival to discharge 67%, compared to 20% in those initiated >72 hours. Overall survival to discharge was 45%, and was higher with VV ECMO (64%), than other configurations (25%). Conclusion ECMO was rarely used in major trauma, the most common indication being severe hypoxaemic respiratory failure secondary to lung injury. In this severely injured cohort, overall survival was poor but better in VV compared to VA and better if initiated early (<72 hours), compared to late.
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Affiliation(s)
- Timothy Amos
- Emergency and Trauma Centre, The Alfred, Australia.
| | | | - Meei Yeung
- National Trauma Research Institute, Australia; Trauma Services, The Alfred, Australia; Breast, Endocrine and General Surgery (BES) Unit, The Alfred, Australia
| | - Julian Gooi
- Cardiothoracic Surgical Unit, The Alfred, Australia
| | | | - Andrew Udy
- Department of Intensive Care & Hyperbaric Medicine, The Alfred, Australia; Australian and New Zealand Intensive Care - Research Centre, Monash University, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute, Australia; Trauma Services, The Alfred, Australia
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15
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Leffall B, Myers L, Holcomb JB, Drake SA. Nursing Care for Extracorporeal Membrane Oxygenation in the Trauma Patient. Crit Care Nurs Q 2021; 44:140-146. [PMID: 33595961 DOI: 10.1097/cnq.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma patients that survive the immediate threat of death are at risk for potentially life-threatening complications such as acute respiratory distress syndrome and multisystem organ failure. Extracorporeal membrane oxygenation (ECMO) use in trauma patients has largely been controversial for concerns of inducing major hemorrhage with the use of systemic anticoagulation to prevent thrombus development while connected to the ECMO circuit. There is limited data available for specific guidelines for optimal management of the trauma population; however, recent studies suggest comparable outcomes to those of nontrauma patients treated with ECMO. The purpose of this case study was to introduce indications for implementation of ECMO in the trauma patient for pulmonary and hemodynamic compromise, describe the procedure of ECMO insertion, and delineate clinical expectations of the intensive care unit nurse within the multidisciplinary ECMO team. This case study presents a 28-year-old man who sustained a gunshot wound of the chest and was ultimately treated with ECMO for pulmonary compromise due to acute respiratory distress syndrome.
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Affiliation(s)
- Britney Leffall
- Houston Methodist Hospital, Houston, Texas (Ms Leffall); Texas Children's Hospital, Houston (Ms Myers); Department of Acute Care Surgery, University of Alabama, Birmingham (Dr Holcomb); and College of Nursing, Texas A&M Institute of Bioscience & Technology, Houston (Dr Drake)
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16
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Evolving role for extracorporeal membrane oxygenation (ECMO) in trauma patients. Int Anesthesiol Clin 2021; 59:31-39. [PMID: 33710001 DOI: 10.1097/aia.0000000000000313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Kim DH, Park JM, Son J, Lee SK. Multivariate Analysis of Risk Factor for Mortality and Feasibility of Extracorporeal Membrane Oxygenation in High-Risk Thoracic Surgery. Ann Thorac Cardiovasc Surg 2021; 27:97-104. [PMID: 33536388 PMCID: PMC8058542 DOI: 10.5761/atcs.oa.20-00224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) as intraoperative cardiorespiratory support during lung transplantation is well known, but use for other types of surgery are limited. To assess risk factor for mortality after high-risk thoracic surgery and feasibility of ECMO, we reviewed. Methods: This study was an observational study. Between January 2011 and October 2018, 63 patients underwent thoracic surgery with ECMO for severe airway disease, pulmonary insufficiency requiring lung surgery, and other conditions. Results: In all, 46 patients remained alive at 30 days after surgery. The mean patient age was 50.38 ± 16.16 years. ECMO was most commonly used to prevent a lethal event (34 [73.9%]) in the Survival (S) group and rescue intervention (13 [76.5%]) in the Non-survival (N) group. In all, 11 patients experienced arrest during surgery (S vs N: 2 [4.3%] vs 9 [52.9%], p ≤0.001). The multivariate analysis revealed that arrest during surgery (odds ratio [OR], 24.44; 95% confidence interval [CI], 1.82–327.60; p = 0.016) and age (OR, 7.47; 95% CI, 1.17–47.85; p = 0.034) were independently associated with mortality. Conclusions: ECMO provides a safe environment during thoracic surgery, and its complication rate is acceptable except for extracorporeal cardiopulmonary resuscitation (ECPR).
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Affiliation(s)
- Do Hyung Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jong Myung Park
- Department of Thoracic and Cardiovascular Surgery, Busan Medical Center, Yeonje-Gu, Busan, Korea
| | - Joohyung Son
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Kwang Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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18
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Parker BM, Menaker J, Berry CD, Tesoreiero RB, O'Connor JV, Stein DM, Scalea TM. Single Center Experience With Veno-Venous Extracorporeal Membrane Oxygenation in Patients With Traumatic Brain Injury. Am Surg 2020; 87:949-953. [PMID: 33295187 DOI: 10.1177/0003134820956360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
METHODS We retrospectively reviewed TBI patients ≥ 18 years of age treated with VV-ECMO. The primary outcome was survival to discharge. Secondary outcomes included progression of intracranial hemorrhage, bleeding complications, and episodes of oxygenator thrombosis requiring exchange. Medians and interquartile ranges were reported where appropriate. RESULTS 13 TBI patients received VV-ECMO support during the study period. The median age was 28 years (Interquartile range (IQR) 25-37.5) and 85% were men. Median admission Glasgow coma scale was 5 (IQR 3-13.5). Median injury severity score (ISS) was 48 (IQR 33.5-66). Median pre-ECMO PaO2:FiO2 ratio was 58 (IQR 47-74.5). Five (38.4%) patients survived to discharge. Six patients (46%) received systemic A/C while on ECMO. No patient had worsening of intracranial hemorrhage on computed tomography imaging. There were two bleeding complications in patients on A/C, neither was related to TBI. Four patients required an oxygenator change; 2 in patients on A/C. CONCLUSION VV-ECMO appears safe with TBI. We have demonstrated that A/C can be withheld without increased complications. Traumatic brain injury should not be considered an absolute contraindication to the use of VV-ECMO for severe respiratory failure and should be decided on a case by case basis. Additional research is needed to confirm these preliminary findings.
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Affiliation(s)
- Brandon M Parker
- Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jay Menaker
- Department of Surgery, School of Medicine, University of Maryland Baltimore, MD, USA
| | - Cherisse D Berry
- Department of Surgery, School of Medicine, New York University, New York, NY, USA
| | | | - James V O'Connor
- Department of Surgery, School of Medicine, University of Maryland Baltimore, MD, USA
| | - Deborah M Stein
- Department of Surgery, Univeristy of California, San Francisco, CA, USA
| | - Thomas M Scalea
- Department of Surgery, School of Medicine, University of Maryland Baltimore, MD, USA
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19
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Extracorporeal membrane oxygenation use in Trauma Quality Improvement Program centers: Temporal trends and future directions. J Trauma Acute Care Surg 2020; 89:351-357. [PMID: 32744831 DOI: 10.1097/ta.0000000000002756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased clinical experience and the decreased need for systemic anticoagulation have renewed interest in the use of extracorporeal membrane oxygenation (ECMO) for posttraumatic respiratory and cardiopulmonary failure. The objectives of this study were to describe the incidence and temporal trends of ECMO use at trauma centers, the outcomes of trauma patients undergoing ECMO, and the characteristics of trauma centers providing ECMO. METHODS Data were derived from the American College of Surgeons Trauma Quality Improvement Program data set. We included adults with at least one severe injury admitted to a level I or II trauma center between 2012 and 2016 who received at least 1 day of mechanical ventilation. Patients were categorized based on whether or not they received ECMO during their admission. The primary outcome was change in the incidence of ECMO across study years. We also evaluated patient outcomes and variation in ECMO volumes across centers. RESULTS Of 194,314 severely injured patients undergoing mechanical ventilation across 450 centers, 269 (0.14%) received ECMO. Extracorporeal membrane oxygenation patients had significantly higher mortality than non-ECMO patients (32% vs. 19%). The standardized rate of ECMO from 2012 to 2016 increased significantly from 75.2 to 179.0 cases per 100,000 severely injured patients undergoing mechanical ventilation. The average annual growth rate was 24%. Of the 82 centers(18%) reporting at least 1 ECMO trauma case, 34 (41%) reported only a single case. CONCLUSION The use of ECMO for trauma, although rare, is rapidly increasing. Two thirds of patients who receive ECMO following traumatic injury survive their hospitalization. These data suggest that ECMO represents a potential treatment strategy for trauma patients with respiratory or cardiopulmonary failure. However, given the rarity of the procedure, there exists an opportunity to develop practice guidelines regarding the indications for, and approach to, ECMO in the setting of trauma. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
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20
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Wang C, Zhang L, Qin T, Xi Z, Sun L, Wu H, Li D. Extracorporeal membrane oxygenation in trauma patients: a systematic review. World J Emerg Surg 2020; 15:51. [PMID: 32912280 PMCID: PMC7488245 DOI: 10.1186/s13017-020-00331-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/23/2020] [Indexed: 12/12/2022] Open
Abstract
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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Affiliation(s)
- Changtian Wang
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China.
| | - Lei Zhang
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Tao Qin
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Zhilong Xi
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Lei Sun
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Haiwei Wu
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Demin Li
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
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21
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Oi M, Maruhashi T, Yamamoto D, Kurihara Y, Koizumi H, Asari Y. Intravascular treatment for ruptured facial artery aneurysm via percutaneous cardiopulmonary support device: A case report. Clin Case Rep 2020; 8:1202-1205. [PMID: 32695357 PMCID: PMC7364082 DOI: 10.1002/ccr3.2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 11/15/2022] Open
Abstract
Even in cases of cardiac arrest caused by hemorrhagic shock, when reliable control of the bleeding source is possible, ECPR may be an effective treatment option if anticoagulant therapy is well-managed and is withdrawn early.
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Affiliation(s)
- Marina Oi
- Department of Emergency and Critical Care MedicineKitasato University School of MedicineSagamiharaJapan
| | - Takaaki Maruhashi
- Department of Emergency and Critical Care MedicineKitasato University School of MedicineSagamiharaJapan
| | - Daisuke Yamamoto
- Department of NeurosurgeryKitasato University School of MedicineSagamiharaJapan
| | - Yutaro Kurihara
- Department of Emergency and Critical Care MedicineKitasato University School of MedicineSagamiharaJapan
| | - Hiroyuki Koizumi
- Department of NeurosurgeryKitasato University School of MedicineSagamiharaJapan
| | - Yasushi Asari
- Department of Emergency and Critical Care MedicineKitasato University School of MedicineSagamiharaJapan
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22
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Usman AA, Subramanian M, Raney C, Weaver J, Smith B, Gutsche J, Vernick W, Martin N, Fernandez-Moure J. Recurrent Use of VV ECMO in Refractory Hypoxemia After Penetrating Lung Injury and Multifocal Pneumonia in a Single Individual's ICU Stay. J Cardiothorac Vasc Anesth 2020; 35:1447-1451. [PMID: 32616423 PMCID: PMC7990562 DOI: 10.1053/j.jvca.2020.05.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Asad Ali Usman
- Department of Anesthesiology and Critical Care, Division of Critical Care and Cardiothoracic Anesthesiology, Penn Lung Rescue, University of Pennsylvania, Philadelphia, PA.
| | - Madhu Subramanian
- Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Catherine Raney
- School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica Weaver
- Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Brian Smith
- Department of Anesthesiology and Critical Care, Division of Critical Care and Cardiothoracic Anesthesiology, Penn Lung Rescue, University of Pennsylvania, Philadelphia, PA
| | - Jacob Gutsche
- Department of Anesthesiology and Critical Care, Division of Critical Care and Cardiothoracic Anesthesiology, Penn Lung Rescue, University of Pennsylvania, Philadelphia, PA
| | - William Vernick
- Department of Anesthesiology and Critical Care, Division of Critical Care and Cardiothoracic Anesthesiology, Penn Lung Rescue, University of Pennsylvania, Philadelphia, PA
| | - Niels Martin
- Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Joseph Fernandez-Moure
- Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, University of Pennsylvania, Philadelphia, PA
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23
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Sugiyama T, Ishida T, Yokoyama H, Kumada Y, Shinohara K. The use of veno-venous extracorporeal membrane oxygenation for massive hemoptysis following a traumatic lung injury: a case report. Acute Med Surg 2020; 7:e492. [PMID: 32509313 PMCID: PMC7269769 DOI: 10.1002/ams2.492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/14/2019] [Accepted: 02/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Published reports regarding the use of veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) for massive hemoptysis following a thoracic injury are still scarce. Case Presentation A 34‐year‐old man developed massive hemoptysis from the right lung after a 2 m fall and being compressed with an iron pipe weighing 500 kg. He was immediately intubated using a double‐lumen tube, and one‐lung ventilation was started. Endotracheal hemorrhage was controlled by sealing the right lumen. V‐V ECMO was initiated to endure the lethal hypoxemia while waiting for the right lung to heal. He came off of V‐V ECMO after 17 days and was discharged on foot on day 46. Conclusion The strategy of using V‐V ECMO in combination with one‐lung ventilation is useful and should be strongly considered to save lethal massive hemoptysis cases following traumatic lung injury.
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Affiliation(s)
- Takuya Sugiyama
- Department of Emergency and Critical Care Medicine Ohta Nishinouchi Hospital Koriyama Japan
| | - Tokiya Ishida
- Department of Emergency and Critical Care Medicine Ohta Nishinouchi Hospital Koriyama Japan
| | - Hideyuki Yokoyama
- Department of Emergency and Critical Care Medicine Ohta Nishinouchi Hospital Koriyama Japan
| | - Yoshibumi Kumada
- Department of Emergency and Critical Care Medicine Ohta Nishinouchi Hospital Koriyama Japan
| | - Kazuaki Shinohara
- Department of Emergency and Critical Care Medicine Ohta Nishinouchi Hospital Koriyama Japan
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24
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Akhmerov A, Huang R, Carlson K, Dhillon NK, Ley EJ, Margulies DR, Ramzy D, Barmparas G. Access to extracorporeal life support as a quality metric: Lessons from trauma. J Card Surg 2020; 35:826-830. [PMID: 32092196 DOI: 10.1111/jocs.14474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Access to centers with extracorporeal membrane oxygenation (ECMO) capabilities varies by region and may affect overall outcomes. We assessed the outcomes of trauma patients requiring ECMO support and compared the overall survival of all patients with trauma at facilities with and without ECMO capabilities. METHODS A retrospective review of the National Trauma Data Bank was performed to identify all trauma patients receiving care at ECMO and non-ECMO centers. Baseline patient characteristics and outcomes were analyzed. Adjusted odds ratio (OR) was used to compare survival at ECMO and non-ECMO facilities. RESULTS Between 2007 and 2015, a total of 5 781 123 patients with trauma were identified with 1 983 986 (34%) admitted to an ECMO facility and 3 797 137 (66%) admitted to a non-ECMO facility. A total of 522 (0.03%) patients required ECMO. Both the number of patients with trauma requiring ECMO support and the number of trauma facilities utilizing ECMO increased over the 9-year-study period (4.9 to 13.8 patients per 100 000 admissions, and 18 to 77 centers, respectively). The mortality for ECMO patients was 40.5%. Patients with trauma admitted to ECMO facilities had more severe injuries (injury severity score: 9.0 vs 8.0; P < .001). The overall mortality was 3.3%. The adjusted OR for mortality associated with admission to an ECMO facility vs a non-ECMO facility was 0.96 (95% confidence interval: 0.95-0.97; adjusted P < .001). CONCLUSIONS The use of ECMO for patients with trauma is expanding. Our study demonstrates a survival benefit associated with admission to a facility with ECMO capabilities. Thus, access to ECMO is a potential quality metric for trauma centers.
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Affiliation(s)
- Akbarshakh Akhmerov
- Department of Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Raymond Huang
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kjirsten Carlson
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Navpreet K Dhillon
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J Ley
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel R Margulies
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Danny Ramzy
- Department of Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Galinos Barmparas
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Selective aortic arch perfusion with fresh whole blood or HBOC-201 reverses hemorrhage-induced traumatic cardiac arrest in a lethal model of noncompressible torso hemorrhage. J Trauma Acute Care Surg 2020; 87:263-273. [PMID: 31348400 DOI: 10.1097/ta.0000000000002315] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemorrhage-induced traumatic cardiac arrest (HiTCA) has a dismal survival rate. Previous studies demonstrated selective aortic arch perfusion (SAAP) with fresh whole blood (FWB) improved the rate of return of spontaneous circulation (ROSC) after HiTCA, compared with resuscitative endovascular balloon occlusion of the aorta and cardiopulmonary resuscitation (CPR). Hemoglobin-based oxygen carriers, such as hemoglobin-based oxygen carrier (HBOC)-201, may alleviate the logistical constraints of using FWB in a prehospital setting. It is unknown whether SAAP with HBOC-201 is equivalent in efficacy to FWB, whether conversion from SAAP to extracorporeal life support (ECLS) is feasible, and whether physiologic derangement post-SAAP therapy is reversible. METHODS Twenty-six swine (79 ± 4 kg) were anesthetized and underwent HiTCA which was induced via liver injury and controlled hemorrhage. Following arrest, swine were randomly allocated to resuscitation using SAAP with FWB (n = 12) or HBOC-201 (n = 14). After SAAP was initiated, animals were monitored for a 20-minute prehospital period prior to a 40-minute damage control surgery and resuscitation phase, followed by 260 minutes of critical care. Primary outcomes included rate of ROSC, survival, conversion to ECLS, and correction of physiology. RESULTS Baseline physiologic measurements were similar between groups. ROSC was achieved in 100% of the FWB animals and 86% of the HBOC-201 animals (p = 0.483). Survival (t = 320 minutes) was 92% (11/12) in the FWB group and 67% (8/12) in the HBOC-201 group (p = 0.120). Conversion to ECLS was successful in 100% of both groups. Lactate peaked at 80 minutes in both groups, and significantly improved by the end of the experiment in the HBOC-201 group (p = 0.001) but not in the FWB group (p = 0.104). There was no significant difference in peak or end lactate between groups. CONCLUSION Selective aortic arch perfusion is effective in eliciting ROSC after HiTCA in a swine model, using either FWB or HBOC-201. Transition from SAAP to ECLS after definitive hemorrhage control is feasible, resulting in high overall survival and improvement in lactic acidosis over the study period.
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Lee YY, Baik HJ, Lee H, Kim CH, Chung RK, Han JI, Joo H, Woo JH. Heparin-free veno-venous extracorporeal membrane oxygenation in a multiple trauma patient: A case report. Medicine (Baltimore) 2020; 99:e19070. [PMID: 32000456 PMCID: PMC7004685 DOI: 10.1097/md.0000000000019070] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Extracorporeal membrane oxygenation (ECMO) in multiple trauma patients with post-traumatic respiratory failure can be quite challenging because of the need for systemic anticoagulation, which may lead to excessive bleeding. In the last decade, there is a growing body of evidence that veno-venous ECMO (VV-ECMO) is lifesaving in multiple trauma patients with acute respiratory distress syndrome, thanks to technical improvements in ECMO devices. PATIENT CONCERNS We report a case of a 17-year-old multiple trauma patient who was drunken and had confused mentality. DIAGNOSES She was suffered from critical respiratory failure (life-threatening hypoxemia and severe hypercapnia/acidosis lasting for 70 minutes) accompanied by cardiac arrest and trauma-induced coagulopathy during general anesthesia. INTERVENTIONS We decided to start heparin-free VV-ECMO after cardiac arrest considering risk of hemorrhage. OUTCOMES She survived with no neurologic sequelae after immediate treatment with heparin-free VV-ECMO. LESSONS Heparin-free VV-ECMO can be used as a resuscitative therapy in multiple trauma patients with critical respiratory failure accompanied by coagulopathy. Even in cases in which life-threatening hypoxemia and severe hypercapnia/acidosis last for >1 hours during CPR for cardiac arrest, VV-ECMO could be considered a potential lifesaving treatment.
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Affiliation(s)
- Youn Young Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Hospital
| | - Hee Jung Baik
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Heeseung Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Chi Hyo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Rack Kyung Chung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jong In Han
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Hyunyoung Joo
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Hospital
| | - Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
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Lorini FL, Grazioli L, Manfredi R, Rausa E, Ghitti D, Poli G, Peck M, Cattaneo S. A prolonged and successful heparin-free extracorporeal membrane oxygenation run in isolated thoracic trauma: A case report. Int J Artif Organs 2019; 43:288-291. [PMID: 31702412 DOI: 10.1177/0391398819887400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A 21-year-old patient has been treated in emergency with venovenous extracorporeal membrane oxygenation after severe thoracic trauma causing severe air leak and haemothorax. The extracorporeal assistance was managed without heparin for 10 days till the full recovery of the lung, and no side-effect was recorded.
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Affiliation(s)
- F Luca Lorini
- Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo Grazioli
- Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Emanuele Rausa
- Department of Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Ghitti
- Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giancarla Poli
- Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marcus Peck
- Department of Anaesthesia and Intensive Care, Frimley Park Hospital, Frimley, UK
| | - Sergio Cattaneo
- Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
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28
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Use of ECMO support in pediatric patients with severe thoracic trauma. J Pediatr Surg 2019; 54:2358-2362. [PMID: 30850149 DOI: 10.1016/j.jpedsurg.2019.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/18/2019] [Accepted: 02/03/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has been used in the non-trauma setting for over 30 years. However, the use of ECMO in trauma remains a difficult question, as the risk of bleeding must be weighed against the benefits of cardiopulmonary support. METHODS Retrospective review of children who sustained severe thoracic trauma (chest abbreviated injury score ≥3) and required ECMO support between 2009 and 2016. RESULTS Of the 425 children who experienced severe thoracic trauma, 6 (1.4%) underwent ECMO support: 67% male, median age 4.8 years, median ISS 36, median GCS 3, and overall survival 83%. The median hospital day of ECMO initiation was 2 with a median ECMO duration of 7 days. All cannulations occurred through the right neck regardless of the size of the child. Five initially had veno-venous support with 1 requiring conversion to veno-arterial (VA) support. Both children on VA support suffered devastating cerebrovascular accidents, one of which ultimately led to withdrawal of care and death. Complications in the cohort included: paraplegia (1), neurocognitive defects/dysphonia (1), infected neck hematoma (1), deep femoral venous thrombosis (1), bilateral lower extremity spasticity (1). CONCLUSION This small cohort supports the use of ECMO in children with severe thoracic injuries as a potentially lifesaving intervention, however, not without significant complication. LEVEL OF EVIDENCE IV.
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29
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Puzio T, Murphy P, Gazzetta J, Phillips M, Cotton BA, Hartwell JL. Extracorporeal life support in pediatric trauma: a systematic review. Trauma Surg Acute Care Open 2019; 4:e000362. [PMID: 31565679 PMCID: PMC6744255 DOI: 10.1136/tsaco-2019-000362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/26/2019] [Accepted: 09/01/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction Extracorporeal membrane oxygenation (ECMO) was once thought to be contraindicated in trauma patients, however ECMO is now used in adult patients with post-traumatic acute respiratory distress syndrome (ARDS) and multisystem trauma. Despite acceptance as a therapy for the severely injured adult, there is a paucity of evidence supporting ECMO use in pediatric trauma patients. Methods An electronic literature search of PubMed, MEDLINE, and the Cochrane Database of Collected Reviews from 1972 to 2018 was performed. Included studies reported on ECMO use after trauma in patients ≤18 years of age and reported outcome data. The Institute of Health Economics quality appraisal tool for case series was used to assess study quality. Results From 745 studies, four met inclusion criteria, reporting on 58 pediatric trauma patients. The age range was <1–18 years. Overall study quality was poor with only a single article of adequate quality. Twenty-nine percent of patients were cannulated at adult centers, the remaining at pediatric centers. Ninety-one percent were cannulated for ARDS and the remaining for cardiovascular collapse. Overall 60% of patients survived and the survival rate ranged from 50% to 100%. Seventy-seven percent underwent venoarterial cannulation and the remaining underwent veno-venous cannulation. Conclusion ECMO may be a therapeutic option in critically ill pediatric trauma patients. Consideration should be made for the expansion of ECMO utilization in pediatric trauma patients including its application for pediatric patients at adult trauma centers with ECMO capabilities.
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Affiliation(s)
- Thaddeus Puzio
- Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Patrick Murphy
- Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Josh Gazzetta
- Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael Phillips
- Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bryan A Cotton
- Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
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30
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Lang NW, Schwihla I, Weihs V, Kasparek M, Joestl J, Hajdu S, Sarahrudi K. Survival rate and Outcome of extracorporeal life support (ECLS) for treatment of acute cardiorespiratory failure in trauma patients. Sci Rep 2019; 9:12902. [PMID: 31501453 PMCID: PMC6733857 DOI: 10.1038/s41598-019-49346-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022] Open
Abstract
Extracorporeal life support (ECLS) remains the last option for cardiorespiratory stabilization of severe traumatic injured patients. Currently limited data are available and therefore, the current study assessed the survival rate and outcome of ECLS in a Level I trauma center. Between 2002 and 2016, 18 patients (7 females, 11 males) with an median age of 29.5 IQR 23.5 (range 1–64) years were treated with ECLS due to acute traumatic cardiorespiratory failure. Trauma mechanism, survival rate, ISS, SOFA, GCS, GOS, CPC, time to ECLS, hospital- and ICU stay, surgical interventions, complications and infections were retrospectively assessed. Veno-arterial ECLS was applied in 15 cases (83.3%) and veno-venous ECLS in 3 cases (16.6%). Survivors were significant younger than non-survivors (p = 0.0289) and had a lower ISS (23.5 (IQR 22.75) vs 38.5 (IQR 16.5), p = n.s.). The median time to ECLS cannulation was 2 (IQR 0,25) hours in survivors 2 (IQR 4) in non-survivors. Average GCS was 3 (IQR 9.25) at admission. Six patients (33.3%) survived and had a satisfying neurological outcome with a mean GOS of 5 (IQR 0.25) (p = n.s.). ECLS is a valuable treatment in severe injured patients with traumatic cardiorespiratory failure and improves survival with good neurological outcome. Younger patients and patients with a lower ISS are associated with a higher survival rate. Consideration of earlier cannulation in traumatic cardiorespiratory failure might be beneficial to improve survival.
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Affiliation(s)
- Nikolaus W Lang
- Department of Orthopaedics & Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Ines Schwihla
- Department of Orthopaedics & Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Valerie Weihs
- Department of Orthopaedics & Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Maximilian Kasparek
- Department of Orthopaedics & Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Julian Joestl
- Department of Orthopaedics & Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopaedics & Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Kambiz Sarahrudi
- Department of Orthopaedics & Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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31
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Predictive survival factors of the traumatically injured on venovenous extracorporeal membrane oxygenation: A Bayesian model. J Trauma Acute Care Surg 2019; 88:153-159. [DOI: 10.1097/ta.0000000000002457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Ibrahim AS, Akkari ARM, Raza T, Hassan IF, Akbar A, Alatoum I. Epidemiological and Clinical Profiles of Patients with Acute Respiratory Distress Syndrome Admitted to Medical Intensive Care in Qatar: A Retrospective Analysis of the Data Registry for the Year 2015. Qatar Med J 2019; 2019:3. [PMID: 31384572 PMCID: PMC6664154 DOI: 10.5339/qmj.2019.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/22/2019] [Indexed: 02/02/2023] Open
Abstract
Background: Although acute respiratory distress syndrome (ARDS) is a common reason for admission to intensive care units, limited information is available about the epidemiological and clinical characteristics of these patients in Middle Eastern countries. Qatar is a high per capita income country with a large multinational expatriate population. Hamad General Hospital is our main tertiary referral center with the largest medical intensive care unit (MICU). Method: A retrospective cross-sectional study was conducted to extract data from the MICU registry for 101 patients aged >14 years who were admitted with ARDS from January 2015 to December 2015. Results: In 2015, a total of 101 (14.8%) of 682 patients admitted to MICU were diagnosed with ARDS. Males comprised 71.3% and females 28.7%. The mean age of the study population was 44.96 ± 17.97 years. Community-acquired bacterial and viral pneumonia were the most common reasons for ARDS. Crude mortality rate was 35%. The mean age of survivors was 42.09 ± 13.58 years compared with 50.36 ± 16.84 years of non-survivors (p = 0.008). Mortality was associated with increasing age, the Acute Physiologic Assessment and Chronic Health Evaluation II severity score, lower P/F ratio, higher Murray's score, higher PCO2, lower pH, and circulatory support with vasopressors. Preexisting comorbidities did not contribute to high mortality. No difference in mortality was noted with higher versus lower positive end expiratory pressure. The prone position was used in 8% of the cases. Twenty-seven (27%) patients had undergone salvage therapy with extracorporeal membrane oxygenation (ECMO) that resulted in a survival rate of 44%. ARDS was associated with acute renal failure requiring dialysis in 28.7% of the cases, pneumothoraces in 4%, ventilator-associated pneumonia in 7.9%, and central line-associated bloodstream infection in 2%. ARDS led to a prolonged length of stay compared with the average length of stay in MICU. Conclusion: Community-acquired bacterial and viral pneumonia were the most common causes of ARDS at our center. Critical care outcome correlated with the severity of the disease. ECMO was used as salvage therapy in our center.
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Affiliation(s)
- Abdulsalam Saif Ibrahim
- Division of Medicine Critical Care, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar
| | | | - Tasleem Raza
- Division of Medicine Critical Care, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar
| | - Ibrahim Fawzy Hassan
- Division of Medicine Critical Care, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar
| | - Anzila Akbar
- Division of Medicine Critical Care, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar
| | - Ibrahim Alatoum
- Division of Medicine Critical Care, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar
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33
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Carter KT, Kutcher ME, Shake JG, Panos AL, Cochran RP, Creswell LL, Copeland H. Heparin-Sparing Anticoagulation Strategies Are Viable Options for Patients on Veno-Venous ECMO. J Surg Res 2019; 243:399-409. [PMID: 31277018 DOI: 10.1016/j.jss.2019.05.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/14/2019] [Accepted: 05/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO), a rescue therapy for pulmonary failure, has traditionally been limited by anticoagulation requirements. Recent practice has challenged the absolute need for anticoagulation, expanding the role of ECMO to patients with higher bleeding risk. We hypothesize that mortality, bleeding, thrombotic events, and transfusions do not differ between heparin-sparing and full therapeutic anticoagulation strategies in veno-venous (VV) ECMO management. MATERIALS AND METHODS Adult VV ECMO patients between October 2011 and May 2018 at a single center were reviewed. A heparin-sparing strategy was implemented in October 2014; we compared outcomes in an as-treated fashion. The primary end point was survival. Secondary end points included bleeding, thrombotic complications, and transfusion requirements. RESULTS Forty VV ECMO patients were included: 17 (147 circuit-days) before and 23 (214 circuit-days) after implementation of a heparin-sparing protocol. Patients treated with heparin-sparing anticoagulation had a lower body mass index (28.5 ± 7.1 versus 38.1 ± 12.4, P = 0.01), more often required inotropic support before ECMO (82 versus 50%, P = 0.05), and had a lower mean activated clotting time (167 ± 15 versus 189 ± 15 s, P < 0.01). There were no significant differences in survival to decannulation (59 versus 83%, P = 0.16) or discharge (50 versus 72%, P = 0.20), bleeding (32 versus 33%, P = 1.0), thromboembolic events (18 versus 39%, P = 0.17), or transfusion requirements (median 1.1 versus 0.9 unit per circuit-day, P = 0.48). CONCLUSIONS Survival, bleeding, thrombotic complications, and transfusion requirements did not differ between heparin-sparing and full therapeutic heparin strategies for management of VV ECMO. VV ECMO can be a safe option in patients with traditional contraindications to anticoagulation.
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Affiliation(s)
- Kristen T Carter
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Matthew E Kutcher
- Division of Trauma, Critical Care, and Acute Care Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jay G Shake
- Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Anthony L Panos
- Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Richard P Cochran
- Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lawrence L Creswell
- Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Hannah Copeland
- Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi.
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34
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Aprile V, Korasidis S, Ambrogi MC, Lucchi M. Extracorporeal membrane oxygenation in traumatic tracheal injuries: a bold life-saving option. J Thorac Dis 2019; 11:2660-2663. [PMID: 31463087 DOI: 10.21037/jtd.2019.05.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vittorio Aprile
- Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Stylianos Korasidis
- Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
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35
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Shinar Z, Plantmason L, Reynolds J, Dembitsky W, Bellezzo J, Ho C, Glaser D, Adamson R. Emergency Physician-Initiated Resuscitative Extracorporeal Membrane Oxygenation. J Emerg Med 2019; 56:666-673. [DOI: 10.1016/j.jemermed.2019.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/22/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
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36
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Assessment of safety and bleeding risk in the use of extracorporeal membrane oxygenation for multitrauma patients: A multicenter review. J Trauma Acute Care Surg 2019; 86:967-973. [DOI: 10.1097/ta.0000000000002242] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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37
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Zonies D, Codner P, Park P, Martin ND, Lissauer M, Evans S, Cocanour C, Brasel K. AAST Critical Care Committee clinical consensus: ECMO, nutrition. Trauma Surg Acute Care Open 2019; 4:e000304. [PMID: 31058243 PMCID: PMC6461143 DOI: 10.1136/tsaco-2019-000304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 01/15/2023] Open
Abstract
The American Association for the Surgery of Trauma Critical Care Committee has developed clinical consensus guides to help with practical answers based on the best evidence available. These are focused in areas in which the levels of evidence may not be that strong and are based on a combination of expert consensus and research. Overall, quality of the research is mixed, with many studies suffering from small numbers and issues with bias. The first two of these focus on the use of extracorporeal membrane oxygenation in trauma patients and nutrition for the critically ill surgical/trauma patient.
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Affiliation(s)
- David Zonies
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Panna Codner
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pauline Park
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Niels D Martin
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Lissauer
- Department of Surgery, Rutgers-Robert Wood Johnson, Rutgers, New Jersey, USA
| | - Susan Evans
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Christine Cocanour
- Department of Surgery, University of California Davis, Davis, California, USA
| | - Karen Brasel
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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38
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Reeb J, Olland A, Massard G, Falcoz PE. Extracorporeal life support in thoracic surgery. Eur J Cardiothorac Surg 2019; 53:489-494. [PMID: 29340579 DOI: 10.1093/ejcts/ezx477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jeremie Reeb
- The Strasbourg Lung Transplant Program, Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.,Research unit EA 7293 'Vascular and Tissular Stress in Transplantation', Translational Research Federation, University of Strasbourg, Strasbourg, France
| | - Anne Olland
- The Strasbourg Lung Transplant Program, Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.,Research unit EA 7293 'Vascular and Tissular Stress in Transplantation', Translational Research Federation, University of Strasbourg, Strasbourg, France
| | - Gilbert Massard
- The Strasbourg Lung Transplant Program, Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.,Research unit EA 7293 'Vascular and Tissular Stress in Transplantation', Translational Research Federation, University of Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- The Strasbourg Lung Transplant Program, Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
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39
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A metal organic framework reduces thrombus formation and platelet aggregation ex vivo. J Trauma Acute Care Surg 2018; 85:572-579. [DOI: 10.1097/ta.0000000000001982] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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40
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Monaco F, Belletti A, Bove T, Landoni G, Zangrillo A. Extracorporeal Membrane Oxygenation: Beyond Cardiac Surgery and Intensive Care Unit: Unconventional Uses and Future Perspectives. J Cardiothorac Vasc Anesth 2018; 32:1955-1970. [DOI: 10.1053/j.jvca.2018.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Indexed: 02/06/2023]
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41
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Wu MY, Chou PL, Wu TI, Lin PJ. Predictors of hospital mortality in adult trauma patients receiving extracorporeal membrane oxygenation for advanced life support: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2018; 26:14. [PMID: 29422067 PMCID: PMC5806237 DOI: 10.1186/s13049-018-0481-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background Using extracorporeal membrane oxygenation (ECMO) to provide advanced life support in adult trauma patients remains a controversial issue now. The study was aimed at identifying the independent predictors of hospital mortality in adult trauma patients receiving ECMO for advanced cardiopulmonary dysfunctions. Methods This retrospective study enrolled 36 adult trauma patients receiving ECMO due to advanced shock or respiratory failure in a level I trauma center between August 2006 and October 2014. Variables collected for analysis were demographics, serum biomarkers, characteristics of trauma, injury severity score (ISS), damage-control interventions, indications of ECMO, and associated complications. The outcomes were hospital mortality and hemorrhage on ECMO. The multivariate logistic regression method was used to identify the independent prognostic predictors for the outcomes. Results The medians of age and ISS were 36 (27–49) years and 29 (19–45). Twenty-three patients received damage-control interventions before ECMO. Among the 36 trauma patients, 14 received ECMO due to shock and 22 for respiratory failure. The complications of ECMO are major hemorrhages (n = 12), acute renal failure requiring hemodialysis (n = 10), and major brain events (n = 7). There were 15 patients died in hospital, and 9 of them were in the shock group. Conclusions The severity of trauma and the type of cardiopulmonary dysfunction significantly affected the outcomes of ECMO used for sustaining patients with post-traumatic cardiopulmonary dysfunction. Hemorrhage on ECMO remained a concern while the device was required soon after trauma, although a heparin-minimized protocol was adopted. Trial registration This study reported a health care intervention on human participants and was retrospectively registered. The Chang Gung Medical Foundation Institutional Review Board approved the study (no. 201601610B0) on December 12, 2016. All of the data were extracted from December 14, 2016, to March 31, 2017.
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Affiliation(s)
- Meng-Yu Wu
- Department of Cardiothoracic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. .,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan. .,, Taoyuan, Taiwan, Republic of China.
| | - Pin-Li Chou
- Department of Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tzu-I Wu
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pyng-Jing Lin
- Department of Cardiothoracic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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