Extracorporeal Life Support in Traumatology - Review of 9 Patients between 1997 and 2003

Abstract

Objective: Polytraumatised patients with lung contusion can mainly be treated by aggressive ventilation techniques in order to maintain sufficient organ O₂ perfusion. In rare critical cases adequate tissue oxygenation cannot be achieved, despite high ventilatory procedures. ECMO (extracorporeal membrane oxygenation) can be used for these patients. ECMO is an important part of treatment in trauma patients developing All (acute lung insufficiency), ARDS (adult respiratory distress syndrome) and/or severe hypotension. It is widely accepted that, after fulfilling defined criteria like the Murray lung injury score (LlSS), a pathological Horrowitz index, and chronically elevated peak ventilation pressures, an ECMO is initiated. Methods: This study on 9 trauma patients (6 normothermic, 3 hypothermic) focuses on use of this method in patients in an emergency room or intra- and postoperative setting. Results: Duration time on ECMO in 5 CPR-resuscitated patients was 62.4 hours, in 4 non-resuscitated patients 43.5 hours (chi test p < 0.0036). Three patients suffered from hypothermia after trauma (mean body temperature 22.6 °C). Five patients developed acute hypovolaemic shock and pulmonary failure. In five patients ECMO was initiated in the ER, in one patient intraoperatively during emergency surgery two hours after injury. In three patients ECMO was started in intensive care 24 hours, 48 hours and 5 days after injury. Median duration time of ECMO was 36 hours, average duration 54 hours. CPR was performed in 5 patients, and in 2 non-survivors. The average ISS in total was 22; the average ISS in survivors was 23, in non-survivors 17. The lower ISS in non-survivors results in a lower AIS in the hypothermic patients with minor additional injuries. Three patients died (33 %), 2 of hypothermia, one of MOF after 6 days on ECMO. Four patients survived in good physical health. One patient suffers from tetrapalsy. One suffers from liver dysfunction. Conclusion: This study shows the value of ECMO in acutely injured, critically ill patients during the early period of injury in the ER, OR and ICU. The indications here are pulmonary failure (ARDS), hypovolaemic shock, cardiac support and hypothermia. We conclude therefore that acute ECMO is technically possible in selected trauma patients with severe acute respiratory failure.

polytrauma - trauma centre - ECMO - ARDS - lung contusion - resuscitation - hypothermia - shock

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