Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients.
BACKGROUND
Patients who have massive but potentially survivable injuries frequently die from complications of hypovolemia, hypoxemia, hypothermia, metabolic acidosis, and coagulopathy. Emergency cardiopulmonary bypass has been unsuccessful in preventing such deaths because it involves systemic anticoagulation that exacerbates coagulopathy.


METHODS
A simplified extracorporeal cardiopulmonary life support (ECLS) system was assembled consisting of a centrifugal pump head, heat exchanger, membranous oxygenator, percutaneous cannulas, and heparin-bonded circuitry. The entire system has heparin-bonded surfaces. Patients were resuscitated with the system after femoral vein-femoral artery cannulation. ECLS was used to resuscitate massively injured patients who were deteriorating despite maximal conventional therapy.


RESULTS
While receiving maximal conventional therapy, 6 patients developed hypothermia, metabolic acidosis, and coagulopathy causing pulmonary hemorrhaging and hypoxemia from severe underlying lung injuries. ECLS with heparin-bonded circuitry provided cardiopulmonary support and rewarming while physicians addressed coagulopathies and surgical bleeding and assessed survivability. Three patients survived.


CONCLUSIONS
ECLS with heparin-bonded circuitry offers supplemental capability in the resuscitation and cardiopulmonary support of selected massively injured patients while their primary injuries are being evaluated and treated.
Perchinsky
M J
MJ
Department of Surgery, Legacy Emanuel Hospital, Portland, Oregon 97227, USA.
Long
W B
WB
Hill
J G
JG
Parsons
J A
JA
Bennett
J B
JB
D016887:Cardiopulmonary Resuscitation; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D015601:Injury Severity Score; D008020:Life Support Care; D008171:Lung Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D055370:Lung Injury; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011182:Postoperative Care; D015996:Survival Rate; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*
D006493:Heparin