Pitfalls when using extracorporeal life support in trauma patients

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.

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

Critical Care Medicine ◽

10.1097/00003246-199801001-00104 ◽

1998 ◽

Vol 26 (Supplement) ◽

pp. 52A ◽

Cited By ~ 1

Author(s):

Martin S. Keller ◽

Harry L. Anderson ◽

Perry W. Stafford

Keyword(s):

Respiratory Failure ◽

Life Support ◽

Extracorporeal Life Support ◽

Pediatric Trauma ◽

Trauma Patients

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Extracorporeal life support is safe in trauma patients

Injury ◽

10.1016/j.injury.2016.11.008 ◽

2017 ◽

Vol 48 (1) ◽

pp. 121-126 ◽

Cited By ~ 13

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

Scientific Reports ◽

10.1038/s41598-019-49346-z ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 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.

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Inverted-Takotsubo cardiomyopathy: severe refractory heart failure in poly-trauma patients saved by emergency extracorporeal life support

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivu421 ◽

2014 ◽

Vol 20 (3) ◽

pp. 365-371 ◽

Cited By ~ 13

Author(s):

Massimo Bonacchi ◽

Andrea Vannini ◽

Guy Harmelin ◽

Stefano Batacchi ◽

Marco Bugetti ◽

...

Keyword(s):

Heart Failure ◽

Takotsubo Cardiomyopathy ◽

Life Support ◽

Extracorporeal Life Support ◽

Trauma Patients ◽

Refractory Heart Failure

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Extracorporeal life support in pediatric trauma: a systematic review

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000362 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000362 ◽

Cited By ~ 2

Author(s):

Thaddeus Puzio ◽

Patrick Murphy ◽

Josh Gazzetta ◽

Michael Phillips ◽

Bryan A Cotton ◽

...

Keyword(s):

Life Support ◽

Extracorporeal Life Support ◽

Therapeutic Option ◽

Pediatric Trauma ◽

Case Series ◽

Outcome Data ◽

Trauma Patients ◽

Study Quality ◽

Cochrane Database ◽

Adequate Quality

IntroductionExtracorporeal membrane oxygenation (ECMO) was once thought to be contraindicated in trauma patients, however ECMO is now used in adult patients with post-traumatic acute respiratory distress syndrome (ARDS) and multisystem trauma. Despite acceptance as a therapy for the severely injured adult, there is a paucity of evidence supporting ECMO use in pediatric trauma patients.MethodsAn electronic literature search of PubMed, MEDLINE, and the Cochrane Database of Collected Reviews from 1972 to 2018 was performed. Included studies reported on ECMO use after trauma in patients ≤18 years of age and reported outcome data. The Institute of Health Economics quality appraisal tool for case series was used to assess study quality.ResultsFrom 745 studies, four met inclusion criteria, reporting on 58 pediatric trauma patients. The age range was <1–18 years. Overall study quality was poor with only a single article of adequate quality. Twenty-nine percent of patients were cannulated at adult centers, the remaining at pediatric centers. Ninety-one percent were cannulated for ARDS and the remaining for cardiovascular collapse. Overall 60% of patients survived and the survival rate ranged from 50% to 100%. Seventy-seven percent underwent venoarterial cannulation and the remaining underwent veno-venous cannulation.ConclusionECMO may be a therapeutic option in critically ill pediatric trauma patients. Consideration should be made for the expansion of ECMO utilization in pediatric trauma patients including its application for pediatric patients at adult trauma centers with ECMO capabilities.

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