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

12 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

Fingerprint

Extracorporeal Membrane Oxygenation
Lung Injury
Respiratory Insufficiency
Traumatic Brain Hemorrhage
Mortality
Hemodynamics
Heart Rupture
Oxygen
Cardiac Tamponade
Injury Severity Score
APACHE
Positive-Pressure Respiration
Adult Respiratory Distress Syndrome
Mechanical Ventilators
Blood Volume
Artificial Respiration
Blood Transfusion
Ventilation
Survivors
Pneumonia

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

Cite this

Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure. / Wu, Shih-Chi; Chen, Tzu-Liang; Lin, Hui-Han; Fu, Chih-Yuan; Wang, Yu-Chun; Lo, Hung-Chieh; Cheng, Han-Tsung; Tzeng, Chia-Wei.

In: American Journal of Emergency Medicine, Vol. 33, No. 5, 2015, p. 658-662.

Research output: Contribution to journalArticle

Wu, Shih-Chi ; Chen, Tzu-Liang ; Lin, Hui-Han ; Fu, Chih-Yuan ; Wang, Yu-Chun ; Lo, Hung-Chieh ; Cheng, Han-Tsung ; Tzeng, Chia-Wei. / Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure. In: American Journal of Emergency Medicine. 2015 ; Vol. 33, No. 5. pp. 658-662.
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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. {\circledC} 2015 Elsevier Inc.",
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author = "Shih-Chi Wu and Tzu-Liang Chen and Hui-Han Lin and Chih-Yuan Fu and Yu-Chun Wang and Hung-Chieh Lo and Han-Tsung Cheng and Chia-Wei Tzeng",
note = "Export Date: 24 March 2016 CODEN: AJEME 通訊地址: Wu, S.-C.; Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taiwan 化學物質/CAS: oxygen, 7782-44-7 參考文獻: Rossaint, R., Cerny, V., Coats, T.J., Duranteau, J., Fern{\'a}ndez-Mond{\'e}jar, E., Gordini, G., Key issues in advanced bleeding care in trauma (2006) Shock, 26, pp. 322-331; Krug, E.G., Sharma, G.K., Lozano, R., The global burden of injuries (2000) Am J Public Health, 90, pp. 523-526; Vecsei, V., Arbes, S., Aldrian, S., Nau, T., Chest injuries in polytrauma (2005) Eur J Trauma, 31, pp. 239-243; Brower, R.G., Lanken, P.N., Macintyre, N., Matthay, M.A., Morris, A., Ancukiewicz, M., National Heart, Lung, and Blood Institute ARDS Clinical Trials Network: Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome (2004) N Engl J Med, 351, pp. 327-336; Determann, R.M., Royakkers, A., Wolthuis, E.K., Vlaar, A.P., Choi, G., Paulus, F., Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: A preventive randomized controlled trial (2010) Crit Care, 14 (1), p. R1; Burns, K.E., Adhikari, N.K., Slutsky, A.S., Guyatt, G.H., Villar, J., Zhang, H., Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: A systematic review and meta-analysis (2011) PLoS ONE, 6 (1), p. e14623; Vasilyev, S., Schaap, R.N., Mortensen, J.D., Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units: An international, multicenter, prospective study (1995) Chest, 107, pp. 1083-1088; Maccallum, N.S., Evans, T.W., Epidemiology of acute lung injury (2005) Curr Opin Crit Care, 11 (1), pp. 43-49; Rubenfeld, G.D., Caldwell, E., Peabody, E., Weaver, J., Martin, D.P., Neff, M., Incidence and outcomes of acute lung injury (2005) N Engl J Med, 353 (16), pp. 1685-1693; Villar, J., Blanco, J., A{\~n}{\'o}n, J.M., Santos-Bouza, A., Blanch, L., Ambr{\'o}s, A., The ALIEN study: Incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation (2011) Intensive Care Med, 37 (12), pp. 1932-1941; Checkley, W., Extracorporeal membrane oxygenation as a first-line treatment strategy for ARDS: Is the evidence sufficiently strong? (2011) JAMA, 306, pp. 1703-1704; Peek, G.J., Mugford, M., Tiruvoipati, R., Wilson, A., Allen, E., Thalanany, M.M., Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): A multicentre randomised controlled trial (2009) Lancet, 374, pp. 1351-1363; Keel, M., Meier, C., Chest injuries - What is new? (2007) Curr Opin Crit Care, 13, pp. 674-679; UK collaborative randomized trial of neonatal extracorporeal membrane oxygenation (1996) Lancet, 348, pp. 75-82; Ferguson, N.D., Fan, E., Camporotal, L., Antonelli, M., Anzueto, A., Beale, R., The Berlin definition of ARDS: An expanded rationale, justification, and supplementary material (2012) Intensive Care Med, 38 (10), pp. 1573-1582; Madershahian, N., Wittwer, T., Strauch, J., Franke, U.F., Wippermann, J., Kaluza, M., Application of ECMO in multitrauma patients with ARDS as rescue therapy (2007) J Card Surg, 22, pp. 180-184; Huang, Y.K., Liu, K.S., Lu, M.S., Wu, M.Y., Tsai, F.C., Lin, P.J., Extracorporeal life support in post-traumatic respiratory distress patients (2009) Resuscitation, 80, pp. 535-539; Arlt, M., Philipp, A., Voelkel, S., Rupprecht, L., Mueller, T., Hilker, M., Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock (2010) Resuscitation, 81, pp. 804-809; Bellomo, R., Ronco, C., Kellum, J.A., Mehta, R.L., Palevsky, P., Acute renal failure - Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group (2004) Crit Care, 8, pp. R204-R212; Bouman, C., Kellum, J.A., Lamiere, N., Definition for acute renal failure (2003) Acute Dialysis Quality Initiative - 2nd International Consensus Conference, , http://www.adqi.net; Dellinger, R.P., Levy, M.M., Rhodes, A., Annane, D., Gerlach, H., Opal, S.M., Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 (2013) Crit Care Med, 41, pp. 580-637; Lewandowski, K., Extracorporeal membrane oxygenation for severe acute respiratory failure (2000) Crit Care, 4, pp. 156-168; Cordell-Smith, J.A., Roberts, N., Peek, G.J., Firmin, R.K., Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO) (2006) Injury, 37, pp. 29-32; Ried, M., Bein, T., Philipp, A., M{\"u}ller, T., Graf, B., Schmid, C., Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: A 10-year institutional experience (2013) Crit Care, 17 (3), p. R110; Biderman, P., Einav, S., Fainblut, M., Stein, M., Singer, P., Medalion, B., Extracorporeal life support in patients with multiple injuries and severe respiratory failure: A single-center experience? (2013) J Trauma Acute Care Surg, 75, pp. 907-912; Michaels, A.J., Schriener, R.J., Kolla, S., Awad, S.S., Rich, P.B., Reickert, C., Extracorporeal life support in pulmonary failure after trauma (1999) J Trauma, 46, pp. 638-645; Wolf, M.J., Chanani, N.K., Heard, M.L., Kanter, K.R., Mahle, W.T., Early renal replacement therapy during pediatric cardiac extracorporeal support increases mortality (2013) Ann Thorac Surg, 96 (3), pp. 917-922; Shi, J., Chen, Q., Yu, W., Shen, J., Gong, J., He, C., Continuous renal replacement therapy reduces the systemic and pulmonary inflammation induced by venovenous extracorporeal membrane oxygenation in a porcine model (2014) Artif Organs, 38 (3), pp. 215-223; Shen, J., Yu, W., Chen, Q., Shi, J., Hu, Y., Zhang, J., Continuous renal replacement therapy (CRRT) attenuates myocardial inflammation and mitochondrial injury induced by venovenous extracorporeal membrane oxygenation (VV ECMO) in a healthy piglet model (2013) Inflammation, 36 (5), pp. 1186-1193; Yuan, K.C., Fang, J.F., Chen, M.F., Treatment of endobronchial hemorrhage after blunt chest trauma with extracorporeal membrane oxygenation (ECMO) (2008) J Trauma, 65 (5), pp. 1151-1154; Liao, C.H., Huang, Y.K., Tseng, C.N., Wu, M.Y., Tsai, F.C., Successful use of extracorporeal life support to resuscitate traumatic inoperable pulmonary hemorrhage (2008) J Trauma, 64 (2), pp. E15-E17; Muellenbach, R.M., Redel, A., K{\"u}stermann, J., Brack, A., Gorski, A., R{\"o}sner, T., Extracorporeal membrane oxygenation and severe traumatic brain injury. Is the ECMO-therapy in traumatic lung failure and severe traumatic brain injury really contraindicated? (2011) Anaesthesist, 60 (7), pp. 647-652; Muellenbach, R.M., Kredel, M., Kunze, E., Kranke, P., Kuestermann, J., Brack, A., Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury (2012) J Trauma Acute Care Surg, 72 (5), pp. 1444-1447",
year = "2015",
doi = "10.1016/j.ajem.2015.02.007",
language = "English",
volume = "33",
pages = "658--662",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders",
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}

TY - JOUR

T1 - Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure

AU - Wu, Shih-Chi

AU - Chen, Tzu-Liang

AU - Lin, Hui-Han

AU - Fu, Chih-Yuan

AU - Wang, Yu-Chun

AU - Lo, Hung-Chieh

AU - Cheng, Han-Tsung

AU - Tzeng, Chia-Wei

N1 - Export Date: 24 March 2016 CODEN: AJEME 通訊地址: Wu, S.-C.; Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taiwan 化學物質/CAS: oxygen, 7782-44-7 參考文獻: Rossaint, R., Cerny, V., Coats, T.J., Duranteau, J., Fernández-Mondéjar, E., Gordini, G., Key issues in advanced bleeding care in trauma (2006) Shock, 26, pp. 322-331; Krug, E.G., Sharma, G.K., Lozano, R., The global burden of injuries (2000) Am J Public Health, 90, pp. 523-526; Vecsei, V., Arbes, S., Aldrian, S., Nau, T., Chest injuries in polytrauma (2005) Eur J Trauma, 31, pp. 239-243; Brower, R.G., Lanken, P.N., Macintyre, N., Matthay, M.A., Morris, A., Ancukiewicz, M., National Heart, Lung, and Blood Institute ARDS Clinical Trials Network: Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome (2004) N Engl J Med, 351, pp. 327-336; Determann, R.M., Royakkers, A., Wolthuis, E.K., Vlaar, A.P., Choi, G., Paulus, F., Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: A preventive randomized controlled trial (2010) Crit Care, 14 (1), p. R1; Burns, K.E., Adhikari, N.K., Slutsky, A.S., Guyatt, G.H., Villar, J., Zhang, H., Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: A systematic review and meta-analysis (2011) PLoS ONE, 6 (1), p. e14623; Vasilyev, S., Schaap, R.N., Mortensen, J.D., Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units: An international, multicenter, prospective study (1995) Chest, 107, pp. 1083-1088; Maccallum, N.S., Evans, T.W., Epidemiology of acute lung injury (2005) Curr Opin Crit Care, 11 (1), pp. 43-49; Rubenfeld, G.D., Caldwell, E., Peabody, E., Weaver, J., Martin, D.P., Neff, M., Incidence and outcomes of acute lung injury (2005) N Engl J Med, 353 (16), pp. 1685-1693; Villar, J., Blanco, J., Añón, J.M., Santos-Bouza, A., Blanch, L., Ambrós, A., The ALIEN study: Incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation (2011) Intensive Care Med, 37 (12), pp. 1932-1941; Checkley, W., Extracorporeal membrane oxygenation as a first-line treatment strategy for ARDS: Is the evidence sufficiently strong? (2011) JAMA, 306, pp. 1703-1704; Peek, G.J., Mugford, M., Tiruvoipati, R., Wilson, A., Allen, E., Thalanany, M.M., Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): A multicentre randomised controlled trial (2009) Lancet, 374, pp. 1351-1363; Keel, M., Meier, C., Chest injuries - What is new? (2007) Curr Opin Crit Care, 13, pp. 674-679; UK collaborative randomized trial of neonatal extracorporeal membrane oxygenation (1996) Lancet, 348, pp. 75-82; Ferguson, N.D., Fan, E., Camporotal, L., Antonelli, M., Anzueto, A., Beale, R., The Berlin definition of ARDS: An expanded rationale, justification, and supplementary material (2012) Intensive Care Med, 38 (10), pp. 1573-1582; Madershahian, N., Wittwer, T., Strauch, J., Franke, U.F., Wippermann, J., Kaluza, M., Application of ECMO in multitrauma patients with ARDS as rescue therapy (2007) J Card Surg, 22, pp. 180-184; Huang, Y.K., Liu, K.S., Lu, M.S., Wu, M.Y., Tsai, F.C., Lin, P.J., Extracorporeal life support in post-traumatic respiratory distress patients (2009) Resuscitation, 80, pp. 535-539; Arlt, M., Philipp, A., Voelkel, S., Rupprecht, L., Mueller, T., Hilker, M., Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock (2010) Resuscitation, 81, pp. 804-809; Bellomo, R., Ronco, C., Kellum, J.A., Mehta, R.L., Palevsky, P., Acute renal failure - Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group (2004) Crit Care, 8, pp. R204-R212; Bouman, C., Kellum, J.A., Lamiere, N., Definition for acute renal failure (2003) Acute Dialysis Quality Initiative - 2nd International Consensus Conference, , http://www.adqi.net; Dellinger, R.P., Levy, M.M., Rhodes, A., Annane, D., Gerlach, H., Opal, S.M., Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 (2013) Crit Care Med, 41, pp. 580-637; Lewandowski, K., Extracorporeal membrane oxygenation for severe acute respiratory failure (2000) Crit Care, 4, pp. 156-168; Cordell-Smith, J.A., Roberts, N., Peek, G.J., Firmin, R.K., Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO) (2006) Injury, 37, pp. 29-32; Ried, M., Bein, T., Philipp, A., Müller, T., Graf, B., Schmid, C., Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: A 10-year institutional experience (2013) Crit Care, 17 (3), p. R110; Biderman, P., Einav, S., Fainblut, M., Stein, M., Singer, P., Medalion, B., Extracorporeal life support in patients with multiple injuries and severe respiratory failure: A single-center experience? (2013) J Trauma Acute Care Surg, 75, pp. 907-912; Michaels, A.J., Schriener, R.J., Kolla, S., Awad, S.S., Rich, P.B., Reickert, C., Extracorporeal life support in pulmonary failure after trauma (1999) J Trauma, 46, pp. 638-645; Wolf, M.J., Chanani, N.K., Heard, M.L., Kanter, K.R., Mahle, W.T., Early renal replacement therapy during pediatric cardiac extracorporeal support increases mortality (2013) Ann Thorac Surg, 96 (3), pp. 917-922; Shi, J., Chen, Q., Yu, W., Shen, J., Gong, J., He, C., Continuous renal replacement therapy reduces the systemic and pulmonary inflammation induced by venovenous extracorporeal membrane oxygenation in a porcine model (2014) Artif Organs, 38 (3), pp. 215-223; Shen, J., Yu, W., Chen, Q., Shi, J., Hu, Y., Zhang, J., Continuous renal replacement therapy (CRRT) attenuates myocardial inflammation and mitochondrial injury induced by venovenous extracorporeal membrane oxygenation (VV ECMO) in a healthy piglet model (2013) Inflammation, 36 (5), pp. 1186-1193; Yuan, K.C., Fang, J.F., Chen, M.F., Treatment of endobronchial hemorrhage after blunt chest trauma with extracorporeal membrane oxygenation (ECMO) (2008) J Trauma, 65 (5), pp. 1151-1154; Liao, C.H., Huang, Y.K., Tseng, C.N., Wu, M.Y., Tsai, F.C., Successful use of extracorporeal life support to resuscitate traumatic inoperable pulmonary hemorrhage (2008) J Trauma, 64 (2), pp. E15-E17; Muellenbach, R.M., Redel, A., Küstermann, J., Brack, A., Gorski, A., Rösner, T., Extracorporeal membrane oxygenation and severe traumatic brain injury. Is the ECMO-therapy in traumatic lung failure and severe traumatic brain injury really contraindicated? (2011) Anaesthesist, 60 (7), pp. 647-652; Muellenbach, R.M., Kredel, M., Kunze, E., Kranke, P., Kuestermann, J., Brack, A., Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury (2012) J Trauma Acute Care Surg, 72 (5), pp. 1444-1447

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

KW - oxygen

KW - adult

KW - APACHE

KW - arterial gas

KW - Article

KW - artificial ventilation

KW - blood clotting disorder

KW - blunt trauma

KW - brain hemorrhage

KW - clinical article

KW - extracorporeal oxygenation

KW - female

KW - heart rupture

KW - heart tamponade

KW - heparinization

KW - human

KW - hypercapnia

KW - hypoxemia

KW - injury scale

KW - injury severity

KW - intensive care unit

KW - lung hemodynamics

KW - lung injury

KW - male

KW - oxygen consumption

KW - positive end expiratory pressure

KW - priority journal

KW - respiratory failure

KW - retrospective study

KW - severe traumatic lung injury

KW - survival rate

KW - traffic accident

KW - blood transfusion

KW - cause of death

KW - hemodynamics

KW - length of stay

KW - lung function test

KW - middle aged

KW - mortality

KW - Respiratory Distress Syndrome, Adult

KW - statistics and numerical data

KW - Adult

KW - Blood Transfusion

KW - Cause of Death

KW - Extracorporeal Membrane Oxygenation

KW - Female

KW - Hemodynamics

KW - Humans

KW - Length of Stay

KW - Lung Injury

KW - Male

KW - Middle Aged

KW - Positive-Pressure Respiration

KW - Respiratory Function Tests

KW - Retrospective Studies

KW - Survival Rate

KW - Trauma Severity Indices

U2 - 10.1016/j.ajem.2015.02.007

DO - 10.1016/j.ajem.2015.02.007

M3 - Article

VL - 33

SP - 658

EP - 662

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

IS - 5

ER -