scholarly journals Survival rate and Outcome of extracorporeal life support (ECLS) for treatment of acute cardiorespiratory failure in trauma patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Nikolaus W. Lang ◽  
Ines Schwihla ◽  
Valerie Weihs ◽  
Maximilian Kasparek ◽  
Julian Joestl ◽  
...  
Keyword(s):  
Survival Rate ◽  
Neurological Outcome ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Trauma Patients ◽  
Surgical Interventions ◽  
Cardiorespiratory Failure ◽  
Valuable Treatment ◽  
Level I ◽  
Injured Patients

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.

scholarly journals Pitfalls when using extracorporeal life support in trauma patients

2019 ◽  
Vol 4 (1) ◽  
pp. e000298 ◽  
Author(s):  
Shokei Matsumoto ◽  
Masahi Morizane ◽  
Kiyokuni Matsuo ◽  
Motoyasu Yamazaki ◽  
Mitsuhide Kitano
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Trauma Patients

scholarly journals The Early Initiation of Extracorporeal Life Support May Improve the Neurological Outcome in Adults with Cardiac Arrest due to Cardiac Events

2019 ◽  
Vol 58 (10) ◽  
pp. 1391-1397 ◽  
Author(s):  
Shotaro Komeyama ◽  
Kensuke Takagi ◽  
Hideyuki Tsuboi ◽  
Shigeki Tsuboi ◽  
Yasuhiro Morita ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Early Initiation ◽  
Cardiac Events

scholarly journals Evidence of Prolonged Monitoring of Trauma Patients Admitted via Trauma Resuscitation Unit without Primary Proof of Severe Injuries

2020 ◽  
Vol 9 (8) ◽  
pp. 2516 ◽  
Author(s):  
Martin Heinrich ◽  
Matthias Lany ◽  
Lydia Anastasopoulou ◽  
Christoph Biehl ◽  
Gabor Szalay ◽  
...  
Keyword(s):  
Injury Severity ◽  
Treatment Completion ◽  
Trauma Patients ◽  
Trauma Resuscitation ◽  
Abbreviated Injury Scale ◽  
Severely Injured Patients ◽  
Severe Injuries ◽  
Level I ◽  
Evidence Based Guidelines ◽  
Injured Patients

Introductio: Although management of severely injured patients in the Trauma Resuscitation Unit (TRU) follows evidence-based guidelines, algorithms for treatment of the slightly injured are limited. Methods: All trauma patients in a period of eight months in a Level I trauma center were followed. Retrospective analysis was performed only in patients ≥18 years with primary TRU admission, Abbreviated Injury Scale (AIS) ≤ 1, Maximum Abbreviated Injury Scale (MAIS) ≤ 1 and Injury Severity Score (ISS) ≤3 after treatment completion and ≥24 h monitoring in the units. Cochran’s Q-test was used for the statistical evaluation of AIS and ISS changes in units. Results: One hundred and twelve patients were enrolled in the study. Twenty-one patients (18.75%) reported new complaints after treatment completion in the TRU. AIS rose from the Intermediate Care Unit (IMC) to Normal Care Unit (NCU) 6.2% and ISS 6.9%. MAIS did not increase >2, and no intervention was necessary for any patient. No correlation was found between computed tomography (CT) diagnostics in TRU and AIS change. Conclusions: The data suggest that AIS, MAIS and ISS did not increase significantly in patients without a severe injury during inpatient treatment, regardless of the type of CT diagnostics performed in the TRU, suggesting that monitoring of these patients may be unnecessary.

Efficacy of Extracorporeal Life Support in the Setting of Adult Cardiorespiratory Failure

ASAIO Journal ◽  
1994 ◽  
Vol 40 (3) ◽  
pp. M339-M343 ◽  
Author(s):  
Thomas Pranikoff ◽  
Ronald B. Hirschl ◽  
Cynthia N. Steimle ◽  
Harry L. Anderson ◽  
Robert H. Bartlett
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Cardiorespiratory Failure

Medication Errors in Injured Patients

2017 ◽  
Vol 83 (7) ◽  
pp. 780-785 ◽  
Author(s):  
Scott C. Dolejs ◽  
Christopher F. Janowak ◽  
Ben L. Zarzaur
Keyword(s):  
Medication Error ◽  
Patient Outcomes ◽  
Medication Errors ◽  
Injury Severity ◽  
Trauma Patients ◽  
Lengths Of Stay ◽  
Scale Scores ◽  
Level I ◽  
Injured Patients ◽  
The Impact

Trauma patients are vulnerable to medication error given multiple handoffs throughout the hospital. The purpose of this study was to assess trends in medication errors in trauma patients and the role these errors play in patient outcomes. Injured adults admitted from 2009 to 2015 to a Level I trauma center were included. Medication errors were determined based on a nurse-driven, validated, and prospectively maintained database. Multivariable logistic regression modeling was used to control for differences between groups. Among 15,635 injured adults admitted during the study period, 132 patients experienced 243 errors. Patients who experienced errors had significantly worse injury severity, lower Glasgow Coma Scale scores and higher rates of hypotension on admission, and longer lengths of stay. Before adjustment, mortality was similar between groups but morbidity was higher in the medication error group. After risk adjustment, there were no significant differences in morbidity or mortality between the groups. Medication errors in trauma patients tend to occur in significantly injured patients with long hospital stays. Appropriate adjustment when studying the impact of medical errors on patient outcomes is important.

Practical application of bedside diagnostics in determining limb viability

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 151-153
Author(s):  
Anahita Dua ◽  
Sapan S Desai ◽  
Sheila Coogan
Keyword(s):  
Lower Limb ◽  
Arterial Injury ◽  
Trauma Patients ◽  
Practical Application ◽  
Post Injury ◽  
Normal Limits ◽  
Study Results ◽  
Data Points ◽  
Level I ◽  
Injured Patients

Introduction This study aimed to determine the practical application of vascular lab studies in determining limb salvage outcomes in injured patients with concerning clinical examinations. Methods A retrospective review of the trauma registry at a level I center was conducted from January 2009 to June 2013. All patients >16 years of age who sustained a lower limb arterial injury had a concerning clinical exam (mottled skin, decreased skin warmth, diminished pulses) and had vascular lab studies to determine management were included. Data-points included demographics, type and location of injury, procedure type, vascular lab study results, and limb outcome. Results Over a five-year period, 11 trauma patients met inclusion criteria. Five of these patients had concerning clinical exams after revascularization, and six observed patients had a concerning clinical examination during the course of their hospitalization. All 11 patients had vascular lab studies that were within normal limits. As a result of normal vascular lab studies, none of these patients underwent further imaging or intervention. None of these patients underwent amputation. Conclusion Vascular lab studies may be utilized to determine the need for intervention and/or lower limb bypass sufficiency in patients with questionable clinical examinations post injury.

Hematocrit and impact of transfusion in patients receiving extracorporeal life support

Perfusion ◽  
2018 ◽  
Vol 33 (7) ◽  
pp. 546-552 ◽  
Author(s):  
Justyna Swol ◽  
Christopher Marschall ◽  
Justus T. Strauch ◽  
Thomas A. Schildhauer
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Entire Group ◽  
Binary Logistic Regression Analysis ◽  
Trauma Patients ◽  
Significance Level

Introduction: Increasing the hematocrit is considered to increase oxygen delivery to the patient, especially when hypoxic conditions exist and the patient may become more stable. The aim of this study was to evaluate the relationship between hematocrit and hospital mortality via subgroup analyses of trauma and non-trauma patients. Methods: The hospital length of stay (LOS) and LOS in the intensive care unit (ICU) and hospital after extracorporeal life support (ECLS) treatment of 81 patients were analyzed and compared. In-hospital survival until extracorporeal membrane oxygen (ECMO) weaning and hospital discharge were defined as the clinical outcome. Results: Significantly increased mortality, with a relative risk of 1.73 with a 95% confidence interval of 1.134 to 2.639, was identified in the group with an hematocrit greater than 31%. However, no significant differences in relative risk (95% confidence interval) of death for each group were found among groups with an hematocrit less than or equal to 25%, 26-28% and 29-31%. Additionally, no significant relationship between survival and median hematocrit level was observed at a significance level of 0.413 and an Exp (B) of 1.089 at a 95% confidence interval of 0.878 to 1.373 in binary logistic regression analysis; a model was established with a -2 log likelihood of 40.687 for the entire group of patients. Moreover, a significant increase in mortality was observed as the average number of transfusions per day in the hospital increased (significance level 0.024, Exp (B) 4.378, 95% confidence interval for Exp (B) 1.212 to 15.810). Conclusion: Because a variety of factors influence therapy, the indication for transfusion should be re-evaluated and adapted repeatedly on a case-by-case basis. Further studies are needed to demonstrate whether an acceptable outcome from ECLS device therapy can also be achieved with a low hematocrit and a restrictive indication for transfusion.

EXTRACORPOREAL LIFE SUPPORT (ECLS) FOR PEDIATRIC TRAUMA PATIENTS WITH RESPIRATORY FAILURE

1998 ◽  
Vol 26 (Supplement) ◽  
pp. 52A ◽  
Author(s):  
Martin S. Keller ◽  
Harry L. Anderson ◽  
Perry W. Stafford
Keyword(s):  
Respiratory Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Pediatric Trauma ◽  
Trauma Patients

Blood Transfusions in Trauma: Six-Year Analysis of the Transfusion Practices at a Level I Trauma Center

2008 ◽  
Vol 74 (10) ◽  
pp. 953-957 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Didem Oncel ◽  
Demetrios Demetriades ◽  
Kenji Inaba ◽  
Ira Shulman ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Negative Impact ◽  
Fresh Frozen Plasma ◽  
Blood Transfusions ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Level I ◽  
Injured Patients

The objective of this study was to analyze the transfusion practices in trauma patients in one institution. A retrospective analysis of the Trauma Registry linked with the Blood Bank Database of a Level 1 trauma center was conducted. Over 6 years, 17 per cent of the 25,599 trauma patients received blood transfusions. The overall mortality in transfused patients was 20 per cent and remained the same during the study period. There was no change in the proportion of patients receiving transfusions throughout the years, however there was a significant 23.5 per cent reduction in the mean number of packed red blood cells (PRBC) units transfused (P < 0.001 for trend). This reduction in PRBC used remained true and even more evident in the group of more severely injured patients (Injury Severity Score ≥ 16), with a 27.9 per cent decrease in mean units of PRBC (P < 0.001 for trend). The highest reduction in PRBC transfusion was seen in blunt trauma patients (34.6%, P < 0.001). During the study period there was a concurrent increase in mean units of fresh frozen plasma used (60.7%, P < 0.001) and no change in the use of platelets and cryoprecipitate. In conclusion, transfusions of PRBC were significantly reduced over time in trauma patients without any evident negative impact on mortality.

Extracorporeal life support is safe in trauma patients

Injury ◽  
2017 ◽  
Vol 48 (1) ◽  
pp. 121-126 ◽  
Author(s):  
Christopher R. Burke ◽  
Angelena Crown ◽  
Titus Chan ◽  
D. Michael McMullan
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Trauma Patients
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