Extracorporeal organ support following trauma

Abstract

Abstract : Death after severe trauma in the civilian and military setting occurs in a trimodal distribution. Historically, the majority of injury-related mortality occurs in the prehospital setting owing to hemorrhage. Of patients who survive to hospital admission, another group of deaths occurs in the acute phase owing to devastating head injury or uncontrolled hemorrhage. Among patients who survive these immediate and acute phases of trauma, the last significant phase of mortality occurs in the days and weeks following injury from sepsis and multiple organ failure (MOF). The immediate care of the severely injured is guided by structured clinical practice guidelines that have been widely adopted for the prehospital and early hospital settings. Early use of tourniquets, hemostatic dressings, and the concepts of damage-control surgery and hemostatic resuscitation have led to more patients surviving the immediate and early phases of severe trauma. As advances in prevention and treatment of death from hemorrhage occur, there may be an expected decrease in mortality during the early aspects of the trimodal pattern of mortality. Specifically, improved survivability of the initial phases of injury can be expected to result in a greater number of physiologically compromised patients prone to MOF surviving later into the hospitalization. As such, directing a significant portion of current and future clinical expertise and scientific study to advanced organ support techniques is prudent.