title: The use of venovenous extracorporeal membrane oxygenation in sheep receiving severe smoke inhalation injury.
abstract: Smoke inhalation injury now represents the most frequent cause of death in burn patients, and accounts for 20-80 per cent of overall mortality. We have studied the use of extracorporeal membrane oxygenation (ECMO) to support sheep which have received lethal pulmonary smoke damage. The animals (n = 19) received inhalation injury induced by insufflation with smoke derived from burning cotton delivered with a bee smoker. The treatment group, those placed on ECMO at the time of injury (n=6), were systemically heparinized and placed on a venovenous perfusion circuit consisting of a roller pump, membrane oxygenator and heat exchanger. Blood flow rate in the circuit approximated 20-25 per cent of cardiac output. The animals remained on partial venovenous bypass until the termination of the experiment 96 h after injury. All animals in the treatment group survived. The control sheep (n = 7) received inhalation injury alone and had a 100 per cent mortality (P = 0.0015 ECMO vs. control). Ventilatory management of treatment and control groups followed an identical protocol. We have also studied a third group (n = 6) composed of animals receiving inhalation injury with systemic heparinization but not ECMO. This group had a 66 per cent mortality at 96 h. These studies suggest that partial venovenous ECMO may be a valuable form of adjunctive treatment in severe inhalation injury.
mesh_terms: D000818:Animals; D002059:Burns, Inhalation / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D005268:Femoral Vein; D006493:Heparin / Q000627:therapeutic use; D010107:Oxygenators, Membrane; D012119:Respiration; D012121:Respiration, Artificial; D012756:Sheep; D014683:Vena Cava, Superior
chemical_list: D006493:Heparin