1300: TWO CASES OF MULTIPLE TRAUMA PATIENTS WITH SEVERE CHEST TRAUMAS TREATED STRATEGICALLY USING VV ECMO

Abstract

Introduction: VV-ECMO is widely used for severe respiratory failure due to endogenous diseases. Alternatively, there is little experience with its use for chest traumas. In this report, we describe two cases of severe chest traumas in which VV-ECMO was introduced and saved the patient’s life. Description: Case 1: A man in his 20s was injured in a collision accident with a passenger car while riding on the rear seat of a motorcycle. He was diagnosed with multiple left rib fractures, left hemopneumothorax, bilateral lung contusions, thoracolumbar rupture fracture, and left humerus fracture. The patient was intubated, and a left thoracic drain was inserted. The respiratory condition of the patient worsened because of increased subcutaneous emphysema caused by bronchial injury and bleeding in the airway; therefore, VV-ECMO was introduced on the third day. The bronchial injury was healed conservatively, and the patient was weaned off from VV-ECMO on the 10th day after spontaneous respiration was eliminated during respiratory support with VV-ECMO. The patient was transferred to the hospital on the 42nd day. Case 2: A man in his 70s was injured when his chest was caught in a commercial elevator. He was diagnosed with bilateral hemopneumothorax, tracheobronchial injury, aortic injury, 5th thoracic vertebra dislocation, and multiple rib fractures. Tracheal intubation and bilateral thoracic drains were inserted, and TAE was performed for multiple vascular injuries, including the internal thoracic artery. The VV-ECMO was performed on the same day because of the patient’s massive hemothorax and worsening respiratory condition due to bronchial injury. Thoracic endovascular aortic repair, bronchial repair, and posterior thoracic fusion were performed with a sufficient respiratory support by VV-ECMO. Furthermore, the patient was weaned off from VV-ECMO on the 24th day. The patient was transferred to the hospital on the 53rd day. Discussion: These experiences demonstrated that ECMO is useful not only for endogenous diseases but also for chest traumas. Currently, there is no fixed opinion on the treatment strategies including surgeries and the anticoagulants use under VV-ECMO. Therefore, decisions must be made on a case-by-case basis.