Extracorporeal life support for patients with significant orthopaedic trauma

Extracorporeal life support is a therapeutic modality that can provide cardiorespiratory support for multiply injured patients. Fourteen patients with multiple trauma who sustained pelvic or long bone fractures were referred for treatment with extracorporeal life support at the University of Michigan Medical Center. All patients were considered morlbund secondary to their pulmonary injury. Six of the 14 patients had bilateral pulmonary contusions. The mean Injury Severity Score was 19. Twelve of the 14 patients had femoral or pelvic fractures or both. Eight patients had orthopaedic injuries initially treated with traction. The most common complication during extracorporeal life support management was bleeding, which occurred in eight of 14 patients. Eight of the 14 patients survived. Seven of eight patients with less than 6 days of mechanical ventilation before initiation of extracorporeal life support survived. Only one of six patients with six or more days of mechanical ventilation before initiation of extracorporeal life support survived. Patients with significant orthopaedic trauma and severe pulmonary compromise have an extremely high mortality risk. Appropriate aggressive fracture management remains the most important intervention to decrease the risk of pulmonary compromise. Early initiation of extracorporeal life support can be an additional lifesaving intervention in select patients with orthopaedic trauma who have respiratory failure refractory to conventional mechanical ventilation.