title: Venoarterial extracorporeal life support in post-traumatic shock and cardiac arrest: lessons learned.
abstract: OBJECTIVE
  Venoarterial extracorporeal life support (VA-ECLS) is an effective support of acute hemodynamic collapse caused by miscellaneous diseases. However, using VA-ECLS for post-traumatic shock is controversial and may induce a disastrous hemorrhage. To investigate the feasibility of using VA-ECLS to treat post-traumatic shock or cardiac arrest (CA), a single-center experience of VA-ECLS in traumatology was reported.
  
  
  METHODS
  This retrospective study included nine patients [median age: 37 years, interquartile range (IQR): 26.5-46] with post-traumatic shock/CA who were treated with VA-ECLS in a single institution between November 2003 and October 2012. The causes of trauma were high-voltage electrocution (n = 1), penetrating chest trauma (n = 1), and blunt chest or poly-trauma (n = 7). Medians of the injury severity score and the maximal chest abbreviated injury scale were 34 (IQR: 15.5-41) and 4 (IQR: 3-4), respectively. All patients received peripheral VA-ECLS without heparin infusion for at least 24 hours.
  
  
  RESULTS
  The median time from arrival at our emergency department (ED) to VA-ECLS was 6 h (IQR: 4-47.5). The median duration of VA-ECLS was 91 h (IQR: 43-187) with a duration < 24 h in 2 patients. Among the 9 patients, 5 received VA-ECLS to treat the post-traumatic shock/CA presenting during (n = 2) or following (n = 3) damage-control surgeries for initial trauma, and another 4 patients were supported for non-surgical complications associated with initial trauma. VA-ECLS was terminated in 2 non-survivors owing to uncontrolled hemothorax or retroperitoneal hemorrhage. Three patients survived to hospital discharge. All of them received damage-control surgeries for initial trauma and experienced a complicated hospitalization after weaning off VA-ECLS.
  
  
  CONCLUSIONS
  Using VA-ECLS to treat post-traumatic shock/CA is challenging and requires multidisciplinary expertise.
authors: Yuan-His
authors: YH
authors: Tseng
authors: Tzu-I
authors: TI
authors: Wu
authors: Yuan-Chang
authors: YC
authors: Liu
authors: Pyng-Jing
authors: PJ
authors: Lin
authors: Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fushing Street, Kueishan Hsiang, Taoyuan, Taiwan. archer3627@gmail.com.
authors: Meng-Yu
authors: MY
authors: Wu
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D008020:Life Support Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012774:Shock, Traumatic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome