title: The use of double lumen cannula for veno-venous ECMO in trauma patients with ARDS.
abstract: BACKGROUND
  The use of a double lumen cannula for veno-venous extracorporeal membrane oxygenation (v.v. ECMO) offers several advantages such as cannulation with only one cannula, patient comfort and the earlier mobilization and physiotherapy. The cannulation should be performed under visual wire and cannula placement into the right atrium, which is associated with risks of malposition and right ventricular perforation. The aim of this patient series is to describe the use of double lumen cannula in trauma patients with posttraumatic ARDS.
  
  
  METHODS
  Criteria for the v.v ECMO treatment were defined as hypoxaemia (pO2/FiO2 < 200 mmHg, FiO2 0.8-1,0); tidal volume >4-6 ml/kg ideal body weight; mean inspiratory pressure (Pinsp) >32-34 mmHg; respiratory acidosis pH <7.25; and arterial saturation (SaO2) <90%. The analysis included the Injury Severity Score (ISS), the types of injury, time of treatment, complications and outcomes.
  
  
  RESULTS
  A total of 24 patients with major trauma were treated for posttraumatic ARDS with v.v. ECMO. The double lumen cannula (Avalon®, Fa. Maquet, Rastatt, Germany) was used in six male patients. The mean ISS was 31 (20-48). The ECMO therapy was started in an average on the third day after trauma. The mean ECMO run time was 7 days ± 5 (6-18), and the hospital stay was in mean of 60 days ± 34 (21-105).
  
  
  CONCLUSIONS
  The use of double lumen cannula for v.v ECMO therapy in trauma patients is a feasible treatment option. No higher risk of bleeding could be found in this case series. A PTT-controlled heparinization is recommended using double lumen cannula. Therefore the use of this cannula type in trauma patients with high risk of bleeding is to discuss controversially.
authors.affiliation: Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany. martin.gothner@bergmannsheil.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Gothner
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr-University, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany. dirk.buchwald@bergmannsheil.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Buchwald
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr-University, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany. justus.strauch@bergmannsheil.de.
authors.forename: Justus T
authors.initials: JT
authors.lastname: Strauch
authors.affiliation: Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany. chirurgie@bergmannsheil.de.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schildhauer
authors.affiliation: Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany. justyna.swol@bergmannsheil.de.
authors.forename: Justyna
authors.initials: J
authors.lastname: Swol
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*