Extracorporeal membrane oxygenation improves coagulopathy in an experimental traumatic hemorrhagic model.
OBJECTIVE
Hemorrhage is the most common cause of preventable death after trauma. Coagulopathy plays a central role in uncontrolled bleeding and is caused by multiple factors. Extracorporeal Membrane Oxygenation (ECMO) is an established treatment for patients with respiratory failure and has in recent years also been used in severely injured trauma patients with cardiopulmonary failure and coexisting bleeding shock. The aim of this study was to evaluate the effect of ECMO on hypothermia, acidosis, and coagulopathy in a traumatic hemorrhagic rabbit model.


METHODS
After anesthesia and tracheostomy, ten New Zealand White rabbits sustained laparotomy, bilateral femur fractures and were hemorrhaged 45% of their estimated blood volume. After 90 min of hemorrhagic shock they were resuscitated with a standard transfusion protocol together with venoarterial ECMO (n = 5) or with a standard transfusion protocol only (n = 5) for 60 min. No systemic heparin was administered.


RESULTS
ECMO during 60 min of resuscitation significantly increased heart rate (p = 0.01), mean arterial pressure (p = 0.01), body temperature (p = 0.01) and improved the metabolic acidosis, pH (p = 0.01), and lactate (p = 0.01). ECMO also improved the coagulation capacity measured in vitro by Rotational Thromboelastometry with a significant decrease in clot formation time (p < 0.01). This finding was confirmed in vivo with a significant reduction in the animals' ear bleeding time (p < 0.01) and cuticle bleeding time (p < 0.01); 5/5 animals survived in the ECMO group and 3/5 animals survived in the control group.


CONCLUSIONS
Heparin-free ECMO stabilizes circulation, improves coagulation, and may impact short-time survival, during the first 60 min, in an experimental traumatic model with severe hemorrhagic shock.
Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden. magnus.larsson@karolinska.se.|ECMO Department Karolinska University Hospital, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden. magnus.larsson@karolinska.se.
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http://orcid.org/0000-0002-7944-5891
M
Larsson
ECMO Department Karolinska University Hospital, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden.
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P
Forsman
Department of Clinical Sciences, Swedish University of Agricultural Sciences, SE-750 07, Uppsala, Sweden.
P
P
Hedenqvist
Department of Anesthesiology and Intensive Care, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden.
A
A
Östlund
ECMO Department Karolinska University Hospital, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden.
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J
Hultman
Department of Clinical Immunology and Transfusion Medicine, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden.
A
A
Wikman
Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden.|Department of Vascular Surgery/Trauma Center, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden.
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L
Riddez
ECMO Department Karolinska University Hospital, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden.
B
B
Frenckner
Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
M
M
Bottai
Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden.|Department of Vascular Surgery/Trauma Center, Karolinska Institutet and University Hospital, SE-171 76, Stockholm, Sweden.
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CM
Wahlgren
D000818:Animals; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation; D005264:Femoral Fractures / Q000150:complications*; D008297:Male; D011817:Rabbits; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
Animal model; Coagulopathy; ECMO; Extracorporeal circulation; Hemorrhage; Resuscitation; Shock; Trauma