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Extracorporeal membrane oxygenation after traumatic injury
Sarwat B Ahmad1, Jay Menaker, Joseph Kufera
1From the Department of Surgery, University of Maryland School of Medicine (S.B.A., J.M., J.O., T.M.S., D.M.S.); R Adams Cowley Shock Trauma Center, Baltimore, Maryland (J.M., J.K., J.O., T.M.S., D.M.S.).
The Journal of Trauma and Acute Care Surgery
|February 23, 2017
Summary
Extracorporeal membrane oxygenation (ECMO) for acute respiratory failure after trauma is complex. Venovenous ECMO use in select trauma patients may improve survival, especially if systemic anticoagulation is tolerated.
Area of Science:
- Trauma critical care
- Respiratory failure management
- Extracorporeal life support
Background:
- The application of extracorporeal membrane oxygenation (ECMO) for acute respiratory failure following injury remains controversial and lacks comprehensive description.
- Limited data exists on the efficacy and outcomes of ECMO in trauma patients.
Purpose of the Study:
- To evaluate the association between patient demographics, clinical variables, and in-hospital mortality in trauma patients treated with ECMO.
- To analyze outcomes of venovenous ECMO in a Level 1 trauma center.
Main Methods:
- Retrospective review of 46 adult trauma patients treated with ECMO from January 2006 to November 2015.
- Exclusion of patients requiring venoarterial ECMO, focusing on 39 patients treated with venovenous ECMO.
- Analysis of demographic data, Injury Severity Score (ISS), physiological parameters, complications, and survival rates.
Main Results:
- 44% of patients undergoing venovenous ECMO survived to discharge.
- Nonsurvivors had higher median ISS (41 vs. 25) and lower arterial pH on arrival.
- Systemic anticoagulation with heparin was significantly associated with improved survival (94% vs. 55%).
Conclusions:
- Venovenous ECMO may be a viable option for specific acute lung injury patient populations after trauma.
- The ability to tolerate systemic anticoagulation appears to be a critical factor for improved survival in trauma patients on ECMO.
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