Venoarterial extracorporeal life support in post-traumatic shock and cardiac arrest: Lessons learned

Yuan His Tseng, Tzu I. Wu, Yuan Chang Liu, Pyng Jing Lin, Meng Yu Wu

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objectives: Venoarterial extracorporeal life support (VA-ECLS) is an effective support of acute hemodynamic collapse caused by miscellaneous diseases. However, using VA-ECLS for post-traumatic shock is controversial and may induce a disastrous hemorrhage. To investigate the feasibility of using VA-ECLS to treat post-traumatic shock or cardiac arrest (CA), a single-center experience of VA-ECLS in traumatology was reported.Materials and methods: This retrospective study included nine patients [median age: 37 years, interquartile range (IQR): 26.5-46] with post-traumatic shock/CA who were treated with VA-ECLS in a single institution between November 2003 and October 2012. The causes of trauma were high-voltage electrocution (n = 1), penetrating chest trauma (n = 1), and blunt chest or poly-trauma (n = 7). Medians of the injury severity score and the maximal chest abbreviated injury scale were 34 (IQR: 15.5-41) and 4 (IQR: 3-4), respectively. All patients received peripheral VA-ECLS without heparin infusion for at least 24 hours.Results: The median time from arrival at our emergency department (ED) to VA-ECLS was 6 h (IQR: 4-47.5). The median duration of VA-ECLS was 91 h (IQR: 43-187) with a duration <24 h in 2 patients. Among the 9 patients, 5 received VA-ECLS to treat the post-traumatic shock/CA presenting during (n = 2) or following (n = 3) damage-control surgeries for initial trauma, and another 4 patients were supported for non-surgical complications associated with initial trauma. VA-ECLS was terminated in 2 non-survivors owing to uncontrolled hemothorax or retroperitoneal hemorrhage. Three patients survived to hospital discharge. All of them received damage-control surgeries for initial trauma and experienced a complicated hospitalization after weaning off VA-ECLS.Conclusion: Using VA-ECLS to treat post-traumatic shock/CA is challenging and requires multidisciplinary expertise.

Original languageEnglish
Article number12
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume22
Issue number1
DOIs
Publication statusPublished - Feb 7 2014

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Keywords

  • Blunt chest trauma
  • Cardiac arrest
  • Extracorporeal life support
  • Extracorporeal membrane oxygenation
  • Traumatic shock

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

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