title: Nonoperative Damage Control: The Use of Extracorporeal Membrane Oxygenation in Traumatic Bronchial Avulsion as a Bridge to Definitive Operation.
abstract: The conventional treatment for an avulsed bronchus is emergent thoracotomy and repair or lobectomy. The principles of damage control thoracic operations include initial hemorrhage control with delayed definite repair after physiologic resuscitation. We report a multiply injured patient with avulsion of the left lower lobe bronchus. Profound acidosis, hypercarbia, and hypoxia precluded an emergent operation, and venovenous extracorporeal membrane oxygenation (V-V ECMO) was used for organ support during physiologic resuscitation. After the achievement of physiologic repletion, a thoracotomy and lobectomy were performed while the patient was supported by V-V ECMO.
authors.affiliation: Henry Ford Hospital, Detroit, Michigan.
authors.forename: Nathan H
authors.initials: NH
authors.lastname: Schmoekel
authors.affiliation: University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland. Electronic address: joconnor@umm.edu.
authors.forename: James V
authors.initials: JV
authors.lastname: O'Connor
authors.affiliation: University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001980:Bronchi / Q000293:injuries* / Q000601:surgery; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015505:Chest Tubes; D003646:Debridement; D004630:Emergencies; D016724:Empyema, Pleural / Q000150:complications; D011464:Epoprostenol / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D011013:Pneumonectomy; D011300:Preoperative Care; D017582:Renal Replacement Therapy; D012131:Respiratory Insufficiency / Q000209:etiology; D013203:Staphylococcal Infections / Q000150:complications; D013908:Thoracotomy; D014949:Wounds, Nonpenetrating / Q000601:surgery / Q000628:therapy*
chemical_list: D002316:Cardiotonic Agents; D011464:Epoprostenol