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Extracorporeal life support for respiratory failure after multiple trauma
H L Anderson1, M B Shapiro, R E Delius
1Department of Surgery, University of Michigan Medical School, Ann Arbor 48109-0331.
The Journal of Trauma
|August 1, 1994
Summary
Extracorporeal life support (ECLS) can be a life-saving option for multiple trauma patients experiencing severe respiratory failure unresponsive to standard ventilation. Early ECLS intervention in these critical cases improves survival rates despite bleeding risks.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Cardiopulmonary Support
Background:
- Respiratory failure is a severe complication in multiple trauma patients, increasing morbidity and mortality.
- Conventional ventilatory management is often insufficient for refractory respiratory failure in trauma.
Observation:
- This study evaluated 24 multiple trauma patients with refractory respiratory failure treated with extracorporeal life support (ECLS).
- Patients experienced injuries from various mechanisms including motor vehicle crashes, pedestrian collisions, and penetrating trauma.
- ECLS was administered via venovenous or venoarterial routes with continuous heparin anticoagulation.
Findings:
- The average duration of ECLS support was 287 hours (approximately 12 days).
- The primary complication observed was bleeding, affecting 75% of patients.
- A survival rate of 63% was achieved, with 15 patients discharged.
Implications:
- Early initiation of ECLS (within 5 days of mechanical ventilation) correlated with better outcomes.
- Despite anticoagulation risks, ECLS offers a viable, life-saving intervention for refractory respiratory failure in severe trauma.
- ECLS can reduce mortality and improve outcomes in complex trauma cases unresponsive to conventional treatments.