Venovenous Extracorporeal Membrane Oxygenation in Severe Polytrauma

Abstract

   BACKGROUND. Road transport injuries (RTI) are the leading cause of death among the working-age population at present. Often, severe combined trauma is accompanied by significant damage to the chest with the development of severe respiratory disorders. Standard methods of intensive therapy for respiratory failure are often ineffective. The use of extracorporeal membrane oxygenation (ECMO) can be an effective method of reducing mortality in this category of patients, evenin conditions where it is impossible to use systemic anticoagulation.   AIM OF THE STUDY. Consider the use of ECMO in patients with serious polytrauma trauma and a high risk of hemorrhagic complications.   MATERIAL AND METHODS. Patient R., 43 years old, got a severe combined injury in a traffic accident; due to progressive acute respiratory failure, veno-venous ECMO (VV-ECMO) was performed for 11 days.   RESULTS. This report reviews a clinical observation of the successful use of VV-ECMO in a patient with severe acute respiratory distress syndrome as a result of polytrauma in a road accident. Due to the high risk of hemorrhagic complications, the procedure was performed without the use of systemic anticoagulation, which is a rather rare case in modern intensive care. On the 11th day, the VV-ECMO procedure was stopped. On the 7th day of VV-ECMO, an intense hemorrhagic syndrome developed as a complication, which was successfully treated. On the 13th day after weaning, the patient was transferred from the intensive care unit to the rehabilitation center.   CONCLUSIONS. The venovenous extracorporeal membrane oxygenation method can be considered as part of the treatment of severe acute respiratory distress syndrome as a result of severe chest trauma when standard methods of respiratory support are ineffective. With a high risk of hemorrhagic complications, which is often observed in patients in this category, it is possible to use venovenous extracorporeal membrane oxygenation without systemic anticoagulation.