Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure.
OBJECTIVE
The use of extracorporeal membrane oxygenation (ECMO) in managing acute respiratory distress syndrome had been accepted. Severe lung injury with respiratory failure is often encountered in trauma patients. We report our experience with the use of ECMO in severe traumatic lung injury.


METHODS
Patients with severe traumatic lung injury that met the following criteria were candidates for ECMO: (1) severe hypoxemia, Pao2/fraction of inspired oxygen (1.0) less than 60, and positive end-expiratory pressure greater than 10 cm H2O in spite of vigorous ventilation strategy; (2) irreversible CO2 retention with unstable hemodynamics; and (3) an initial arterial Pao2/fraction of inspired oxygen (1.0) less than 60, where the pulmonary condition and hemodynamics rapidly deteriorated despite vigorous mechanical ventilation strategy.


RESULTS
Over 60 months, a total of 19 patients with severe traumatic lung injury who received ECMO management were retrospectively reviewed. The median age was 38 years (25-58 years), the median injury severity score was 29 (25-34), the median admission Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 25 (21-36), and the median blood transfusion volume was 5500 mL (3500-13 000). There were 9 venovenous and 10 venoarterial types. The survival rate was 68.4% (13/19). The survivors were younger (30 vs 53 years; 21-39 vs 48-63). There were 6 mortalities (3 pneumonia, 2 coagulopathy, and 1 cardiac rupture with cardiac tamponade). There were 5 of 19 patients with pre-ECMO traumatic brain hemorrhage (3 survived and 2 mortalities). A total of 16 patients received heparinization with 5 mortalities.


CONCLUSIONS
The use of ECMO may offer an additional treatment modality in severe traumatic lung injury with respiratory failure that is unresponsive to optimal conventional ventilator support. Timely ECMO intervention is of value.
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: rw114@mail.cmuh.org.tw.
Shih-Chi
SC
Wu
School of Medicine, China Medical University, Taichung, Taiwan; Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan. Electronic address: wtchen@mail.cmuh.org.tw.
William Tzu-Liang
WT
Chen
Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan. Electronic address: d10760@mail.cmuh.org.tw.
Hui-Han
HH
Lin
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linko, Taiwan. Electronic address: drfu5564@yahoo.com.tw.
Chih-Yuan
CY
Fu
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: traumawang@yahoo.com.tw.
Yu-Chun
YC
Wang
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: carfishcat@yahoo.com.tw.
Hung-Chieh
HC
Lo
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: howardcheng324@gmail.com.
Han-Tsung
HT
Cheng
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: D11814@mail.cmuh.org.tw.
Chia-Wei
CW
Tzeng
D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002423:Cause of Death; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D055370:Lung Injury / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D015996:Survival Rate; D015599:Trauma Severity Indices