Abstract
BackgroundTherapeutic extracorporeal membrane oxygenation (ECMO) is a challenging procedure in patients who have experienced severe trauma. Particularly, patients with traumatic lung injury and posttraumatic acute respiratory distress syndrome (ARDS) have a high risk of bleeding during this procedure. This study aimed to determine the safety and feasibility of ECMO in patients with traumatic ARDS.MethodsWe retrospectively reviewed medical records and investigated the clinical outcomes of ECMO in 42 patients with traumatic ARDS, among whom near-drowning (42.9%) was the most frequent cause of injury.ResultsThirty-four of 42 patients (81%) survived and were discharged after a median hospital stay of 23 days. A multivariate analysis identified a lactate level (odds ratio: 1.493, 95% confidence interval: 1.060–2.103, P = 0.022) and veno-venous (VV) ECMO (odds ratio: 0.075, 95% confidence interval: 0.006–0.901, P = 0.041) as favorable independent predictors of survival in patients with traumatic ARDS who underwent ECMO. The optimal cut off value for pre-ECMO lactate level was 10.5 mmol/L (area under the curve = 0.929, P = 0.001). In Kaplan-Meier analysis, the survival rate at hospital discharge was significant higher among the patients with a pre-ECMO lactate level of 10.5 mmol/L or less compared with patients with pre-ECMO lactate level greater than 10.5 mmol/L (93.8% versus 40.0%, respectively; P = 0.01).ConclusionsECMO yielded excellent survival outcomes, particularly in patients with low pre-treatment lactate levels who received VV ECMO. Therefore, ECMO appears safe and highly feasible in a carefully selected population of trauma patients.
Highlights
Therapeutic extracorporeal membrane oxygenation (ECMO) is a challenging procedure in patients who have experienced severe trauma
We aimed to evaluate our experiences with ECMO support in patients with lifethreatening acute traumatic lung injury and their clinical outcomes, and to identify the significant factors associated with survival outcomes
We retrospectively reviewed the data from 42 consecutive patients who received ECMO respiratory support for severe trauma-induced acute respiratory failure between January 2007 and December 2018
Summary
Therapeutic extracorporeal membrane oxygenation (ECMO) is a challenging procedure in patients who have experienced severe trauma. Patients with traumatic lung injury and posttraumatic acute respiratory distress syndrome (ARDS) have a high risk of bleeding during this procedure. Sepsis and trauma are among the most common causes of acute lung injury or acute respiratory distress syndrome (ARDS) [1]. Severe trauma is generally accompanied by various injuries, including traumatic lung injury, leading to posttraumatic ARDS in some patients [2]. Major trauma-induced lung injury is associated with mortality rates as high as 50–80% due to direct consequences of the injury or secondary effects, such as hypoxemia and respiratory acidosis, including the injured brain [3]. Trauma patients have a high risk of bleeding and have not been considered suitable candidates for ECMO due to the limited experience of the attending medical practitioners. The utility of ECMO in trauma patients remains unclear
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