Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock.
OBJECTIVE
Death to trauma is caused by disastrous injuries on scene, bleeding shock or acute respiratory failure (ARDS) induced by trauma and massive blood transfusion. Extracorporeal membrane oxygenation (ECMO) can be effective in severe cardiopulmonary failure, but preexisting bleeding is still a contraindication for its use. We report our first experiences in application of initially heparin-free ECMO in severe trauma patients with resistant cardiopulmonary failure and coexisting bleeding shock retrospectively and describe blood coagulation management on ECMO.


METHODS
From June 2006 to June 2009 we treated adult trauma patients (n=10, mean age: 32+/-14 years, mean ISS score 73+/-4) with percutaneous veno-venous (v-v) ECMO for pulmonary failure (n=7) and with veno-arterial (v-a) ECMO in cardiopulmonary failure (n=3). Diagnosis included polytrauma (n=9) and open chest trauma (n=1). We used a new miniaturised ECMO device (PLS-Set, MAQUET Cardiopulmonary AG, Hechingen, Germany) and performed initially heparin-free ECMO.


RESULTS
Prior to ECMO median oxygenation ratio (OR) was 47 (36-90) mmHg, median paCO(2) was 67 (36-89) mmHg and median norepinephrine demand was 3.0 (1.0-13.5) mg/h. Cardiopulmonary failure was treated effectively with ECMO and systemic gas exchange and blood flow improved rapidly within 2 h on ECMO in all patients (median OR 69 (52-263) mmHg, median paCO(2) 41 (22-85) mmHg. 60% of our patients had recovered completely.


CONCLUSIONS
Initially heparin-free ECMO support can improve therapy and outcome even in disastrous trauma patients with coexisting bleeding shock.
Arlt
Matthias
M
Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany. matthias.arlt@klinik.uni-regensburg.de
Philipp
Alois
A
Voelkel
Sabine
S
Rupprecht
Leopold
L
Mueller
Thomas
T
Hilker
Michael
M
Graf
Bernhard M
BM
Schmid
Christof
C
D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult