Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure

Shih-Chi Wu, Tzu-Liang Chen, Hui-Han Lin, Chih-Yuan Fu, Yu-Chun Wang, Hung-Chieh Lo, Han-Tsung Cheng, Chia-Wei Tzeng

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objectives: The use of extracorporeal membrane oxygenation (ECMO) in managing acute respiratory distress syndrome had been accepted. Severe lung injury with respiratory failure is often encountered in trauma patients. We report our experience with the use of ECMO in severe traumatic lung injury. Methods: Patients with severe traumatic lung injury that met the following criteria were candidates for ECMO: (1) severe hypoxemia, Pao2/fraction of inspired oxygen (1.0) less than 60, and positive end-expiratory pressure greater than 10 cm H2O in spite of vigorous ventilation strategy; (2) irreversible CO2 retention with unstable hemodynamics; and (3) an initial arterial Pao2/fraction of inspired oxygen (1.0) less than 60, where the pulmonary condition and hemodynamics rapidly deteriorated despite vigorous mechanical ventilation strategy. Results: Over 60 months, a total of 19 patients with severe traumatic lung injury who received ECMO management were retrospectively reviewed. The median age was 38 years (25-58 years), the median injury severity score was 29(25-34), the median admission Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 25(21-36), and the median blood transfusion volume was 5500 mL (3500-13 000). There were 9 venovenous and 10 venoarterial types. The survival rate was 68.4% (13/19). The survivors were younger (30 vs 53 years; 21-39 vs 48-63). There were 6 mortalities (3 pneumonia, 2 coagulopathy, and 1 cardiac rupture with cardiac tamponade). There were 5 of 19 patients with pre-ECMO traumatic brain hemorrhage (3 survived and 2 mortalities). A total of 16 patients received heparinization with 5 mortalities. Conclusions: The use of ECMO may offer an additional treatment modality in severe traumatic lung injury with respiratory failure that is unresponsive to optimal conventional ventilator support. Timely ECMO intervention is of value. © 2015 Elsevier Inc.
Original languageEnglish
Pages (from-to)658-662
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number5
DOIs
Publication statusPublished - 2015
Externally publishedYes

Keywords

  • oxygen
  • adult
  • APACHE
  • arterial gas
  • Article
  • artificial ventilation
  • blood clotting disorder
  • blunt trauma
  • brain hemorrhage
  • clinical article
  • extracorporeal oxygenation
  • female
  • heart rupture
  • heart tamponade
  • heparinization
  • human
  • hypercapnia
  • hypoxemia
  • injury scale
  • injury severity
  • intensive care unit
  • lung hemodynamics
  • lung injury
  • male
  • oxygen consumption
  • positive end expiratory pressure
  • priority journal
  • respiratory failure
  • retrospective study
  • severe traumatic lung injury
  • survival rate
  • traffic accident
  • blood transfusion
  • cause of death
  • hemodynamics
  • length of stay
  • lung function test
  • middle aged
  • mortality
  • Respiratory Distress Syndrome, Adult
  • statistics and numerical data
  • Adult
  • Blood Transfusion
  • Cause of Death
  • Extracorporeal Membrane Oxygenation
  • Female
  • Hemodynamics
  • Humans
  • Length of Stay
  • Lung Injury
  • Male
  • Middle Aged
  • Positive-Pressure Respiration
  • Respiratory Function Tests
  • Retrospective Studies
  • Survival Rate
  • Trauma Severity Indices

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