Abstract
In the USA, trauma represents the leading cause of death between the ages of 1 and 46 years and contributed to 192,000 deaths in 2014. 1 Major trauma is also responsible for significant disabilities and increased hospital length of stay (LOS), and represents a huge financial burden. Acute respiratory failure (ARF) is multifactorial in trauma patients with diverse underlying pathophysiological mechanisms. In a blunt thoracic injury, all the chest compartments can be affected and are directly responsible for mortality of 20–25%. 2 Two main mechanisms contribute to pulmonary injury; the first mechanism is a direct trauma leading to contusion, intra-alveolar hemorrhage, and aspiration pneumonia. Some of the mechanical injuries to the chest (pneumothorax, hemothorax, airways injury) are reversible by various interventions (pleural drains, surgical airway repair, etc.). The second mechanism is an indirect immunological lung injury, which may result from extrapulmonary trauma and/or the required management of tr...
Highlights
Ait Hssain and Raza results and use of Extracorporeal membrane oxygenation (ECMO) worldwide for severe acute respiratory distress syndrome (ARDS), use of ECMO in trauma patient is poorly studied
Severe Acute respiratory failure (ARF) requiring mechanical ventilation (MV) in trauma patients is associated with high mortality and increased hospital length of stay (LOS)
The heterogeneity and complexity of trauma patients make ECMO use challenging in trauma cases with uncertain benefit/risk balance and multidisciplinary decision-making becomes extremely important on a case-by-case basis
Summary
Ait Hssain and Raza results and use of ECMO worldwide for severe ARDS, use of ECMO in trauma patient is poorly studied. In patients with severe impaired gas exchange despite optimized MV, ECMO is proposed to avoid injurious lung ventilation. These patients may require earlier ECMO support compared with non-brain-injured patients, to prevent secondary neurological injury from severe hypoxemia, hypercapnic acidosis, and worsening cerebral edema from fluid overload.
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