title: Extracorporeal life support in patients with multiple injuries and severe respiratory failure: a single-center experience?
abstract: BACKGROUND
  The use of extracorporeal life support in trauma casualties is limited by concerns regarding hemorrhage, particularly in the presence of traumatic brain injury (TBI). We report the use of extracorporeal membrane oxygenation (ECMO)/interventional lung assist (iLA) as salvage therapy in trauma patients. High-flow technique without anticoagulation was used in patients with coagulopathy or TBI.
  
  
  METHODS
  Data were collected from all adult trauma patients referred to one center for ECMO/iLA treatment owing to severe hypoxemic respiratory failure.
  
  
  RESULTS
  Ten casualties had a mean (SD) Injury Severity Score (ISS) of 50.3 (10.5) (mean [SD] age, 29.8 [7.7] years; 60% male) and were supported 9.5 (4.5) days on ECMO (n = 5) and 7.6 (6.5) days on iLA (n = 5). All experienced blunt injury with severe chest injuries, including one cardiac perforation. Most were coagulopathic before initiation of ECMO/iLA support. Among the seven patients with TBI, four had active intracranial hemorrhage. Complications directly related to support therapy were not lethal; these included hemorrhage from a cannulation site (n = 1), accidental removal of a cannula (n = 1), and pressure sores (n = 3). Deaths occurred owing to septic (n = 2) and cardiogenic shock (n = 1). Survival rates were 60% and 80% on ECMO and iLA, respectively. Follow-up of survivors detected no neurologic deterioration.
  
  
  CONCLUSIONS
  ECMO/iLA therapy can be used as a rescue therapy in adult trauma patients with severe hypoxemic respiratory failure, even in the presence of coagulopathy and/or brain injury. The benefits of rewarming, acid-base correction, oxygenation, and circulatory support must be weighed individually against the risk of hemorrhage. Further research should determine whether ECMO therapy also confers survival benefit.
  
  
  METHODS
  Therapeutic study, level V.
authors.affiliation: From the Department of Cardiothoracic Surgery (P.B., M.F., B.M.), Trauma Unit (M.S.), and Department of General Intensive Care (P.S.), Rabin Medical Center, Tel-Aviv University, Tel-Aviv; and General Intensive Care Unit (S.E.), Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel.
authors.forename: Philippe
authors.initials: P
authors.lastname: Biderman
authors.forename: Sharon
authors.initials: S
authors.lastname: Einav
authors.forename: Michael
authors.initials: M
authors.lastname: Fainblut
authors.forename: Michael
authors.initials: M
authors.lastname: Stein
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.forename: Benjamin
authors.initials: B
authors.lastname: Medalion
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D008297:Male; D009104:Multiple Trauma / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome