Abstract
PurposeHemorrhage is the most common cause of preventable death after trauma. Coagulopathy plays a central role in uncontrolled bleeding and is caused by multiple factors. Extracorporeal Membrane Oxygenation (ECMO) is an established treatment for patients with respiratory failure and has in recent years also been used in severely injured trauma patients with cardiopulmonary failure and coexisting bleeding shock. The aim of this study was to evaluate the effect of ECMO on hypothermia, acidosis, and coagulopathy in a traumatic hemorrhagic rabbit model.MethodsAfter anesthesia and tracheostomy, ten New Zealand White rabbits sustained laparotomy, bilateral femur fractures and were hemorrhaged 45% of their estimated blood volume. After 90 min of hemorrhagic shock they were resuscitated with a standard transfusion protocol together with venoarterial ECMO (n = 5) or with a standard transfusion protocol only (n = 5) for 60 min. No systemic heparin was administered.ResultsECMO during 60 min of resuscitation significantly increased heart rate (p = 0.01), mean arterial pressure (p = 0.01), body temperature (p = 0.01) and improved the metabolic acidosis, pH (p = 0.01), and lactate (p = 0.01). ECMO also improved the coagulation capacity measured in vitro by Rotational Thromboelastometry with a significant decrease in clot formation time (p < 0.01). This finding was confirmed in vivo with a significant reduction in the animals’ ear bleeding time (p < 0.01) and cuticle bleeding time (p < 0.01); 5/5 animals survived in the ECMO group and 3/5 animals survived in the control group.ConclusionsHeparin-free ECMO stabilizes circulation, improves coagulation, and may impact short-time survival, during the first 60 min, in an experimental traumatic model with severe hemorrhagic shock.
Highlights
Major trauma is the leading cause of death worldwide in the young population
The ROTEM® analyses were performed on whole blood, collected in tubes containing 0.129 mol l−1 sodium citrate and analyzed according to manufacturer’s instruction ROTEM® Delta 3000 (TEM innovations, GmbH, München, Germany)
This study shows that VA-Extracorporeal Membrane Oxygenation (ECMO) improves acidosis and temperature in a traumatic experimental hemorrhagic model
Summary
Major trauma is the leading cause of death worldwide in the young population. Hemorrhage is the most common preventable cause of death after trauma and accounts for up to 30–40% of trauma-related deaths [1,2,3,4]. Acute traumatic coagulopathy (ATC) is multifactorial, involves the whole process of hemostasis, and is associated with severe injury. Six key factors for initiation of ATC have been identified. They are tissue trauma, shock, hemodilution, hypothermia, acidosis, and inflammation [7]. Hypothermia and metabolic acidosis are late effects of bleeding shock and clearly enhance coagulopathy. Acidosis and hypothermia do not seem to cause clinical relevant effects on protease function until pH is
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