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Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure.
Am J Emerg Med. 2015 May; 33(5):658-62.AJ

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Wu SC
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: rw114@mail.cmuh.org.tw.
Chen WT
School of Medicine, China Medical University, Taichung, Taiwan; Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan. Electronic address: wtchen@mail.cmuh.org.tw.
Lin HH
Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan. Electronic address: d10760@mail.cmuh.org.tw.
Fu CY
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linko, Taiwan. Electronic address: drfu5564@yahoo.com.tw.
Wang YC
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: traumawang@yahoo.com.tw.
Lo HC
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: carfishcat@yahoo.com.tw.
Cheng HT
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: howardcheng324@gmail.com.
Tzeng CW
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: D11814@mail.cmuh.org.tw.

MeSH

AdultBlood TransfusionCause of DeathExtracorporeal Membrane OxygenationFemaleHemodynamicsHumansLength of StayLung InjuryMaleMiddle AgedPositive-Pressure RespirationRespiratory Distress SyndromeRespiratory Function TestsRetrospective StudiesSurvival RateTrauma Severity Indices

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25722287

Citation

Wu, Shih-Chi, et al. "Use of Extracorporeal Membrane Oxygenation in Severe Traumatic Lung Injury With Respiratory Failure." The American Journal of Emergency Medicine, vol. 33, no. 5, 2015, pp. 658-62.
Wu SC, Chen WT, Lin HH, et al. Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure. Am J Emerg Med. 2015;33(5):658-62.
Wu, S. C., Chen, W. T., Lin, H. H., Fu, C. Y., Wang, Y. C., Lo, H. C., Cheng, H. T., & Tzeng, C. W. (2015). Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure. The American Journal of Emergency Medicine, 33(5), 658-62. https://doi.org/10.1016/j.ajem.2015.02.007
Wu SC, et al. Use of Extracorporeal Membrane Oxygenation in Severe Traumatic Lung Injury With Respiratory Failure. Am J Emerg Med. 2015;33(5):658-62. PubMed PMID: 25722287.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure. AU - Wu,Shih-Chi, AU - Chen,William 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, Y1 - 2015/02/07/ PY - 2014/06/28/received PY - 2015/02/03/revised PY - 2015/02/04/accepted PY - 2015/2/28/entrez PY - 2015/2/28/pubmed PY - 2015/7/28/medline SP - 658 EP - 62 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 33 IS - 5 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. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/25722287/Use_of_extracorporeal_membrane_oxygenation_in_severe_traumatic_lung_injury_with_respiratory_failure_ DB - PRIME DP - Unbound Medicine ER -