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Published on: August 15, 2022
Extracorporeal life support in trauma: Indications and techniques.
Alex Lee1, Kali Romano, Gavin Tansley
1From 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.
Extracorporeal life support (ECLS) in trauma offers three key indications: gas exchange, extended damage control, and circulatory support. Standardized techniques are crucial for effective ECLS deployment in complex trauma cases.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Cardiopulmonary Support
Background:
- Extracorporeal life support (ECLS) deployment in trauma requires clear indications and techniques for effective resource management.
- Review of ECLS cases at a tertiary trauma center aimed to define optimal strategies.
Purpose of the Study:
- To review ECLS indications, strategies, and tactics in trauma patients.
- To establish consensus on ECLS use in a trauma setting.
Main Methods:
- Retrospective review of the provincial trauma registry for ECLS patients (January 2014 - February 2021).
- Chart review for indications, technical factors, and outcomes.
- Multidisciplinary team discussion to refine indications and techniques.
Main Results:
- 25 patients received ECLS; 19 survived the ECLS run, 15 to discharge.
- Common complications included vascular injury (n=4) and circuit clots (n=4).
- Three consensus-based indications: gas exchange (lung injury), extended damage control (lethal triad), and circulatory support (shock/hypothermia).
Conclusions:
- ECLS in trauma necessitates standardized planning and techniques for gas exchange, extended damage control, and circulatory support.
- Effective integration of ECLS can enhance the management of complex multisystem trauma injuries.
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