title: Venovenous extracorporeal life support for posttraumatic respiratory distress syndrome in adults: the risk of major hemorrhages.
abstract: BACKGROUND
  The aim of this retrospective study is to investigate the therapeutic benefits and the bleeding risks of venovenous extracorporeal life support (VV-ECLS) when used for adult posttraumatic respiratory distress syndrome (posttraumatic ARDS).
  
  
  METHODS
  Twenty adult trauma patients (median age: 38 years, median injury severity score: 35) treated with VV-ECLS in a level I trauma center between January 2004 and June 2013 were enrolled in this study. The indication of VV-ECLS for posttraumatic ARDS was refractory hypoxemia (PaO2/FiO2 ratio ≤ 70 mmHg) under advanced mechanical ventilation. To minimize potential complications, a protocol-guided VV-ECLS was adopted.
  
  
  RESULTS
  Sixteen patients were weaned off VV-ECLS, and of these patients fourteen survived. Medians of the trauma-to-ECLS time, the pre-ECLS mechanical ventilation, and the ECLS duration in all patients were 64, 45, and 144 hours respectively. The median PaO2/FiO2 ratio was improved significantly soon after VV-ECLS, from 56 to 106 mmHg (p < 0.001). However, seven major hemorrhages occurred during VV-ECLS, of which three were lethal. The multivariate analysis revealed that the occurrence of major hemorrhages during VV-ECLS was independently related to the trauma-to-ECLS time < 24 hours (OR: 20; p = 0.02; 95% CI: 2-239; c-index: 0.81).
  
  
  CONCLUSIONS
  Despite an effective respiratory support, VV-ECLS should be cautiously administered to patients who develop advanced ARDS soon after major trauma.
authors.forename: Meng-Yu
authors.initials: MY
authors.lastname: Wu
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
authors.forename: Yuan-His
authors.initials: YH
authors.lastname: Tseng
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Kao
authors.forename: Hsuan-Ling
authors.initials: HL
authors.lastname: Hsiao
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5, Fushing Street, Gueishan Shiang, Taoyuan 333, Taiwan. david3627@gmail.com.
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008020:Life Support Care / Q000379:methods*; D008297:Male; D011379:Prognosis; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013898:Thoracic Injuries / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications*