title: Transportable extracorporeal lung support for rescue of severe respiratory failure in combat casualties.
abstract: BACKGROUND
  Advances in oxygenator membrane, vascular cannula, and centrifugal pump technologies led to the miniaturization of extracorporeal lung support (ECLS) and simplified its insertion and use. Support of combat injuries complicated by severe respiratory failure requires critical care resources not sustainable in the deployed environment. In response to this need, a unique international military-civilian partnership was forged to create a transportable ECLS capability to rescue combat casualties experiencing severe respiratory failure.
  
  
  METHODS
  A multidisciplinary training and consultative relationship developed between the US military at Landstuhl Regional Medical Center (LRMC) and the University Hospital Regensburg (UHR), a German regional "lung failure" center with expertise in ECLS. ECLS circuits used were pumpless arteriovenous extracorporeal lung assist (NovaLung iLA) and pump-driven venovenous extracorporeal membrane oxygenation (PLS Quadrox D Membrane Oxygenator with Rotaflow Centrifugal Pump). US casualties supported by ECLS between June 2005 and August 2011 were identified from the LRMC Trauma Program Registry for review.
  
  
  RESULTS
  UHR cared for 10 US casualties supported by ECLS. The initial five patients were cannulated with arteriovenous circuits (pumpless arteriovenous extracorporeal lung assist), and the remaining five were cannulated with pump-driven venovenous circuits (extracorporeal membrane oxygenation). Four patients were cannulated in the war zone, and six patients were cannulated at LRMC after evacuation to Germany. All patients were transferred to UHR for continued management (mean, 9.6 ECLS days). In all cases, both hypoxemia and hypercapnia improved, allowing for decreased airway pressures. Nine patients were weaned from ECLS and extubated. One soldier died from progressive multiple-organ failure.
  
  
  CONCLUSIONS
  ECLS should be considered in the management of trauma complicated by severe respiratory failure. Modern ECLS technology allows these therapies to be transported for initiation outside of specialized centers even in austere settings. Close collaboration with established centers potentially allows both military and civilian hospitals with infrequent ECLS requirements to use it for initial patient stabilization before transfer for continued care.
  
  
  METHODS
  Therapeutic/care management study, level V.
authors.affiliation: Departments of Anaesthesia, University of Regensburg, Regensburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bein
authors.forename: David
authors.initials: D
authors.lastname: Zonies
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Markus
authors.initials: M
authors.lastname: Zimmermann
authors.forename: Erik C
authors.initials: EC
authors.lastname: Osborn
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Allan
authors.forename: Michael
authors.initials: M
authors.lastname: Nerlich
authors.forename: Bernhard M
authors.initials: BM
authors.lastname: Graf
authors.forename: Raymond
authors.initials: R
authors.lastname: Fang
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008887:Military Medicine / Q000379:methods; D012131:Respiratory Insufficiency / Q000628:therapy*; D014187:Transportation of Patients / Q000379:methods*; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy*; D014948:Wounds, Gunshot / Q000628:therapy; D055815:Young Adult