Abstract
Extracorporeal life support (ECLS) remains the last option for cardiorespiratory stabilization of severe traumatic injured patients. Currently limited data are available and therefore, the current study assessed the survival rate and outcome of ECLS in a Level I trauma center. Between 2002 and 2016, 18 patients (7 females, 11 males) with an median age of 29.5 IQR 23.5 (range 1–64) years were treated with ECLS due to acute traumatic cardiorespiratory failure. Trauma mechanism, survival rate, ISS, SOFA, GCS, GOS, CPC, time to ECLS, hospital- and ICU stay, surgical interventions, complications and infections were retrospectively assessed. Veno-arterial ECLS was applied in 15 cases (83.3%) and veno-venous ECLS in 3 cases (16.6%). Survivors were significant younger than non-survivors (p = 0.0289) and had a lower ISS (23.5 (IQR 22.75) vs 38.5 (IQR 16.5), p = n.s.). The median time to ECLS cannulation was 2 (IQR 0,25) hours in survivors 2 (IQR 4) in non-survivors. Average GCS was 3 (IQR 9.25) at admission. Six patients (33.3%) survived and had a satisfying neurological outcome with a mean GOS of 5 (IQR 0.25) (p = n.s.). ECLS is a valuable treatment in severe injured patients with traumatic cardiorespiratory failure and improves survival with good neurological outcome. Younger patients and patients with a lower ISS are associated with a higher survival rate. Consideration of earlier cannulation in traumatic cardiorespiratory failure might be beneficial to improve survival.
Highlights
Severe trauma in combination with thoracic injuries are accompanied by life-threatening conditions including cardiorespiratory failure1
Extracorporeal life support (ECLS) remains the last option in patients when other treatment strategies fail4,5,14,15,17
In the current study one third of the patients survived with good neurological outcome
Summary
Severe trauma in combination with thoracic injuries are accompanied by life-threatening conditions including cardiorespiratory failure. The main reasons for traumatic cardiac arrest due to blunt (96,1%) or penetrating (3,9%) thoracic trauma are: hypovolaemia (48%), hypoxaemia (13%), tension pneumothorax (13%) and cardiac tamponade (10%). Severe trauma can cause acute respiratory distress syndrome (ARDS) in up to 10% of the patients. The common causes for traumatic ARDS mostly occurs in blunt thoracic trauma accompanied by pulmonary contusion, hypovolaemic shock, massive transfusion, flail chest due to reanimation, and an ISS (Injury Severity Score) >258,9. Extracorporeal life support (ECLS) remains the last option for acute cardiorespiratory stabilization in these patients. The current study aims to report our experience on the ECLS treatment in trauma patients and addresses the following questions: [1] Which extent of injury severity makes the use of ECLS necessary. The current study aims to report our experience on the ECLS treatment in trauma patients and addresses the following questions: [1] Which extent of injury severity makes the use of ECLS necessary. [2] How long is in average the time between trauma and ECLS-cannulation? [3] How many ECLS related complications occurred? [4] How is the neurological outcome in trauma patients requiring ECLS treatment?
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