title: Use of extracorporeal membrane oxygenation in combination with high-frequency oscillatory ventilation in post-traumatic ARDS.
abstract: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life-threatening complications in trauma patients. Despite the implantation of a veno-venous extracorporeal membrane oxygenation (vv ECMO), sufficient oxygenation (arterial SaO(2)  > 90%) is not always achieved. The additive use of high-frequency oscillation ventilation (HFOV) and ECMO in the critical phase after trauma could prevent the occurrence of life-threatening hypoxaemia and multi-organ failure. We report on a 26-year-old female (Injury Severity Score 29) who had multiple injuries as follows: an unstable pelvic fracture, a blunt abdominal trauma, a blunt trauma of the left thigh, and a thoracic injury. Three days after admission, the patient developed fulminant ARDS (Murray lung injury score of 11 and Horovitz-Index <80 mmHg), and vv ECMO therapy was initiated. The Horovitz-Index was <80 mm Hg, and the lung compliance was minimal. With HFOV, almost complete recruitment of the lung was achieved, and the fraction of inspired oxygen (FiO(2) ) was significantly reduced. The pelvic fracture was treated non-operatively. The HFOV was terminated after 3 days, and the ECMO was stopped after 19 days.
authors.affiliation: Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, Bochum, Germany. martin.gothner@bergmannsheil.de
authors.forename: M
authors.initials: M
authors.lastname: Gothner
authors.forename: D
authors.initials: D
authors.lastname: Buchwald
authors.forename: A
authors.initials: A
authors.lastname: Schlebes
authors.forename: J T
authors.initials: JT
authors.lastname: Strauch
authors.forename: T A
authors.initials: TA
authors.lastname: Schildhauer
authors.forename: J
authors.initials: J
authors.lastname: Swol
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001642:Bicycling / Q000293:injuries; D045422:Continuous Positive Airway Pressure; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000628:therapy; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010388:Pelvis / Q000293:injuries; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy*; D012272:Ribs / Q000293:injuries; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000628:therapy; D014140:Tracheotomy; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy*
chemical_list: D006993:Hypnotics and Sedatives; D010100:Oxygen