scholarly journals National estimates of the use and outcomes of extracorporeal membrane oxygenation after acute trauma

2019 ◽  
Vol 4 (1) ◽  
pp. e000209 ◽  
Author(s):  
Parker J Hu ◽  
Lauren Griswold ◽  
Lauren Raff ◽  
Rachel Rodriguez ◽  
Gerald McGwin Jr ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Statistical Significance ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Traumatic Injuries ◽  
Membrane Oxygenation ◽  
Diagnostic Codes ◽  
The Usa ◽  
Ninth Edition ◽  
National Estimates

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe acute respiratory distress syndrome is gaining greater acceptance among trauma intensivists. The objective of this study was to review ECMO usage in trauma patients in the USA.MethodsThe National Inpatient Sample (NIS) from years 2002 to 2012 was queried for patients aged 15 and older treated with ECMO who had one or more acute traumatic injuries as defined by the International Diagnostic Codes, Ninth Edition (ICD-9). The primary outcomes of interest were incidence of ECMO and overall inpatient mortality.ResultsA total of 1347 patients were identified in the NIS database who had both ECMO performed and ICD-9 codes consistent with trauma. Patients were predominantly aged 15 to 29 years (31.4%) and were male (65.5%). The incidence of ECMO for patients after traumatic injuries has increased 66-fold during the 10-year period. In-hospital mortality was 48.0% overall, with a decreasing trend during the study period that approached statistical significance (p=0.06).DiscussionAlthough ECMO use in patients in the post-trauma setting remains controversial, there is an increasing trend to use ECMO nationwide, suggesting an increasing acceptance and/or increased availability at trauma centers. Given the decrease in mortality during the study period, ECMO as a salvage method in trauma patients remains a potentially viable option. Evaluation in a prospective manner may clarify risks and benefits.Level of evidenceLevel IV, epidemiological.

scholarly journals Making your geriatric and palliative programs a strength: TQIP guideline implementation and the VRC perspective

2021 ◽  
Vol 6 (1) ◽  
pp. e000677
Author(s):  
Vanessa P Ho ◽  
Sasha D Adams ◽  
Kathleen M O'Connell ◽  
Christine S Cocanour ◽  
Saman Arbabi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Best Practice ◽  
Guideline Implementation ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Best Practice Guidelines ◽  
American College Of Surgeons ◽  
Specialized Care ◽  
The Usa

BackgroundOlder patients compose approximately 30% of trauma patients treated in the USA but make up nearly 50% of deaths from trauma. To help standardize and elevate care of these patients, the American College of Surgeons (ACS) Trauma Quality Improvement Program’s best practice guidelines for geriatric trauma management was published in 2013 and that for palliative care was published in 2017. Here, we discuss how palliative care and geriatrics quality metrics can be tracked and used for performance improvement and leveraged as a strength for trauma verification.MethodsWe discuss the viewpoint of the ACS Verification, Review, and Consultation and three case studies, with practical tips and takeaways, of how these measures have been implemented at different institutions.ResultsWe describe the use of (1) targeted educational initiatives, (2) development of a consultation tool based on institutional resources, and (3) application of a nurse-led frailty screen.DiscussionSpecialized care and attention to these vulnerable populations is recommended, but the implementation of these programs can take many shapes.Level of evidence V

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Perfusion ◽  
2021 ◽  
pp. 026765912110128
Author(s):  
Ismael A Salas De Armas ◽  
Bindu Akkanti ◽  
Pratik B Doshi ◽  
Manish Patel ◽  
Sachin Kumar ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Injury Severity ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Trauma Patients ◽  
Membrane Oxygenation ◽  
Trauma Service ◽  
Proper Patient Selection ◽  
Vv Ecmo

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

A64 Trauma patients treated with extracorporeal membrane oxygenation

Injury ◽  
2011 ◽  
Vol 42 ◽  
pp. S17-S18
Author(s):  
A. Keyser ◽  
A. Philipp ◽  
M.K. Hilker ◽  
C. Schmid
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Trauma Patients ◽  
Membrane Oxygenation

Changes in the Levels of Beta-thromboglobulin and Inflammatory Mediators during Extracorporeal Membrane Oxygenation Support

2017 ◽  
Vol 40 (10) ◽  
pp. 575-580 ◽  
Author(s):  
Jae H. Chung ◽  
Hye J. Yeo ◽  
Dohyung Kim ◽  
Sun M. Lee ◽  
Junhee Han ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Platelet Activation ◽  
Plasma Levels ◽  
Statistical Significance ◽  
Early Period ◽  
Platelet Dysfunction ◽  
Platelet Factor ◽  
Membrane Oxygenation

Background Extracorporeal membrane oxygenation (ECMO) has been associated with platelet dysfunction, but no markers of platelet dysfunction during ECMO have been identified. Methods We investigated the potential uses of beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) as markers of platelet activation induced by ECMO in vivo. Results 13 patients who received ECMO for acute respiratory failure were included. Generalized estimating equations were used to examine the associations between days on ECMO and the plasma levels of beta-TG and PF4 and of proinflammatory markers. Analyses were performed before ECMO (baseline) and 24, 48, 72 and 168 hours after the commencement of ECMO. The plasma levels of biomolecules were measured by ELISA and Luminex assay. Percentages of platelets varied widely without statistical significance (p = 0.17). Beta-TG levels significantly decreased over the first 72 hours (p<0.001), but PF4 levels decreased nonsignificantly (p = 0.17). Inflammatory markers, that is, plasma IL-6 (p = 0.03), IL-18 (p<0.001), and MMP-8 (p<0.01) levels stabilized during an early period of ECMO support. Conclusions Our data suggest that ECMO use may not affect platelet activation during the first 3 days of ECMO. Plasma beta-TG levels may allow assessment of the time-dependent extent of ECMO-induced platelet dysfunction in patients with acute respiratory failure.

Acute Kidney Injury in Extracorporeal Membrane Oxygenation Patients: National Analysis of Impact of Age

2021 ◽  
pp. 1-10
Author(s):  
Ankit Sakhuja ◽  
Paul McCarthy ◽  
Jeremiah A. Hayanga ◽  
Steven Turley ◽  
Gordon Smith ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Independent Predictor ◽  
Kidney Injury ◽  
International Classification Of Diseases ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Nationwide Inpatient Sample Database ◽  
The Usa ◽  
National Analysis

<b><i>Background:</i></b> The aim of this study was to determine epidemiology and outcomes of acute kidney injury (AKI) in patients on extracorporeal membrane oxygenation (ECMO) and to assess if age modifies the effect of AKI on mortality. <b><i>Methods:</i></b> Using National (Nationwide) Inpatient Sample Database for hospitalizations in the USA from 2003 to 2014, we identified adult patients on ECMO support. Using International Classification of Diseases 9th Revision, we assessed the rates of AKI and AKI requiring dialysis (AKI-D) among them and associated survival. We used a multivariable logistic regression to identify risk factors of and differential effect of age on mortality from AKI. <b><i>Results:</i></b> AKI was seen in 63.9% of 17,942 ECMO hospitalizations: 21.9% of those with AKI required dialysis. The percentage of those with AKI increased steadily. Mortality was higher in those with AKI, with highest in those with AKI-D (70.8% vs. 61.7%; <i>p</i> &#x3c; 0.001). While both age and AKI were independent predictors of mortality, age was neither a risk factor for AKI nor did it modify the effect of AKI on mortality. <b><i>Conclusions:</i></b> AKI is common and is increasing among patients on ECMO support. Patients on ECMO have high mortality and AKI is an independent predictor of mortality. Though age is also an independent predictor of mortality in patients on ECMO, it is neither a predictor of AKI nor does not modify the relationship between AKI and mortality.

Extracorporeal membrane oxygenation in trauma: A single institution experience and review of the literature

2018 ◽  
Vol 41 (12) ◽  
pp. 845-853 ◽  
Author(s):  
Aaron Strumwasser ◽  
Joshua M Tobin ◽  
Reynold Henry ◽  
Chrissy Guidry ◽  
Caroline Park ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Trauma Patient ◽  
Patient Population ◽  
Injury Severity ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Single Institution ◽  
Membrane Oxygenation ◽  
Severity Scores ◽  
Level I

Introduction: Limited options exist for cardiovascular support of the trauma patient in extremis. This patient population offers challenges that are often considered insurmountable. This article identifies a heterogeneous group of trauma patients in extremis who may benefit from extracorporeal membrane oxygenation. Methods: Data were sourced from the medical records of all patients placed on extracorporeal membrane oxygenation following trauma at a Level I Trauma Center between 1 December 2016 and 1 December 2017. Results: All patients were male (N = 7), mostly with blunt injuries (n = 5), with an average age of 41 years and with an average Injury Severity Scores of 33 (median = 34). Two out of seven patients survived (28.5%). Survivors tended to have a longer duration on extracorporeal membrane oxygenation (13.5 vs 3.8 days), had extracorporeal membrane oxygenation initiated later (15 vs 7.8 days), and had suffered a blunt injury. Two patients were initiated on veno-arterial extracorporeal membrane oxygenation (both non-survivors) and five were initiated on veno-venous extracorporeal membrane oxygenation (two survivors, three non-survivors). Five patients were heparinized immediately (one survivor, four non-survivors), and two patients were heparinized after clotting was noted in the circuit (one survivor, one non-survivor). Three of the seven (42.8%) patients suffered cardiac arrest either prior to, or during, the initiation of extracorporeal membrane oxygenation (all non-survivors). Discussion: Extracorporeal membrane oxygenation use in the trauma patient in extremis is not standard; however, this article demonstrates that extracorporeal membrane oxygenation is feasible in a complex, heterogeneous patient population when treated at designated centers.

scholarly journals AAST Critical Care Committee clinical consensus: ECMO, nutritionExtracorporeal membrane oxygenation (ECMO)Nutrition

2019 ◽  
Vol 4 (1) ◽  
pp. e000304 ◽  
Author(s):  
David Zonies ◽  
Panna Codner ◽  
Pauline Park ◽  
Niels D Martin ◽  
Matthew Lissauer ◽  
...  
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Trauma Patient ◽  
Critically Ill ◽  
American Association ◽  
Expert Consensus ◽  
Surgical Trauma ◽  
Trauma Patients ◽  
Membrane Oxygenation

The American Association for the Surgery of Trauma Critical Care Committee has developed clinical consensus guides to help with practical answers based on the best evidence available. These are focused in areas in which the levels of evidence may not be that strong and are based on a combination of expert consensus and research. Overall, quality of the research is mixed, with many studies suffering from small numbers and issues with bias. The first two of these focus on the use of extracorporeal membrane oxygenation in trauma patients and nutrition for the critically ill surgical/trauma patient.

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