Prolonged use of extracorporeal membrane oxygenation as a rescue modality following traumatic brain injury.
A 21-year-old male trauma patient presented after a motor vehicle crash, witnessed massive aspiration and sustained traumatic brain injury. On postinjury day 3, the patient progressed to adult respiratory distress syndrome (ARDS) refractory to all conventional therapies, prompting the use of extracorporeal membrane oxygenation (ECMO). After 5 days of ECMO support and 3 thrombosed oxygenators, systemic anticoagulation was initiated. After 20 days of ECMO, 15 of which required systemic anticoagulation, the patient was decannulated and transferred to a rehabilitation facility. The patient is currently home without any neurological deficits. Although controversial, ECMO may serve a role as a rescue therapy in ARDS when conventional therapies fail in the brain-injured patient.
From the *Department of Trauma and Acute Care Surgery, George Washington University Hospital, Washington, District of Columbia; †George Washington University School of Medicine, Washington, District of Columbia; ‡Department of Surgery Resident, George Washington University, Washington, District of Columbia; §Department of Cardiothoracic Surgery, George Washington University Hospital, Washington, District of Columbia; and ¶Cardiothoracic Intensive Care Unit, George Washington University Hospital, Washington, District of Columbia.
Jonathan A
JA
Messing
Ritesh V
RV
Agnihothri
Rachel
R
Van Dusen
Farzad
F
Najam
James R
JR
Dunne
Jacqueline R
JR
Honig
Babak
B
Sarani
D000063:Accidents, Traffic; D000925:Anticoagulants / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D006801:Humans; D008297:Male; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology; D055815:Young Adult
D000925:Anticoagulants