Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury.
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) can be used as an "ultima ratio" strategy in multiple injured patients with severe thoracic trauma. However, systemic anticoagulation during ECMO is recommended and thus traumatic brain injury (TBI) and intracranial bleeding are well-accepted contraindications for ECMO therapy.


METHODS
This report describes three cases of prolonged heparin-free venovenous ECMO in multiple injured acute respiratory distress syndrome patients with severe TBI failing conventional mechanical ventilation.


RESULTS
: Using this strategy, neither ECMO-associated bleeding nor clotting of the extracorporeal circuit occurred. All patients survived.


CONCLUSIONS
Based on our experience, we recommend the use of heparin-free ECMO in multiple injured patients with pulmonary failure that is not successfully controlled by lung-protective ventilation even if severe TBI is present.


METHODS
IV, therapeutic study.
Department of Anaesthesia and Critical Care, University of Würzburg, Germany. muellenbac_r@klinik.uni-wuerzburg.de
Ralf M
RM
Muellenbach
Markus
M
Kredel
Ekkehard
E
Kunze
Peter
P
Kranke
Julian
J
Kuestermann
Alexander
A
Brack
Armin
A
Gorski
Christian
C
Wunder
Norbert
N
Roewer
Thomas
T
Wurmb
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants; D001930:Brain Injuries / Q000150:complications* / Q000628:therapy; D000075202:Contraindications; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005500:Follow-Up Studies; D006493:Heparin; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*
D000925:Anticoagulants; D006493:Heparin