title: Benefit of extracorporeal membrane oxygenation in major burns after stun grenade explosion: Experience from a single military medical center.
abstract: BACKGROUND
  Explosion injury is very common on the battlefield and is associated with major burn and inhalation injuries and subsequent high mortality and morbidity rates. Here we report six victims who suffered from explosion injuries caused by stun grenade; all were treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy. This study was aimed to evaluate the indications and efficacy of ECMO in acute and critically ill major burn patients.
  
  
  METHODS
  This was a retrospective analysis of six patients from Tri-Service General Hospital, National Defense Medical Center in Taiwan. All suffered from major burns with 89.0±19.1% average of total body surface area over second degree (TBSA; range, 50-99%). ECMO was used due to inhalation injury in five patients and cardiogenic shock in one patient. The average interval to start ECMO was 26.5±19.0h (range, 14-63h). Venoarterial ECMO was used on in four patients due to unstable hemodynamic status, whereas venovenous ECMO was used in two patients for sustained hypoxemia.
  
  
  RESULTS
  All patients had rhabdomyolysis with acute renal failure. The average duration of ECMO was 169.6±180.9h (range, 27-401h). All patients developed coagulopathy and needed debridement surgery during ECMO support, and five underwent torso escharotomy due to inspiratory compromise. Only one patient whose second and third degree burns covered 50% TBSA was successfully weaned from ECMO and survived; he was discharged after 221 hospital days. All patients who died had second and third degree burns covering over 90% of their TBSA. Three patients died of multiple organ failure, one died of septic shock, and the other died of cardiogenic shock. Overall survival rate was 16.7%.
  
  
  CONCLUSIONS
  In acute and critically ill major burn patients, ECMO could be considered as a salvage therapy, particularly in those with inhalation injury and burn-related acute respiratory distress syndrome. However, ECMO does not seem to provide benefits for circulatory support in those with hemodynamic compromise. The use of ECMO in these patients is still investigational, as our data provided no benefit in terms of the outcomes or survival, particularly in those with more than 90% TBSA burns.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Po-Shun
authors.initials: PS
authors.lastname: Hsu
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Tsai
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Shyi-Gen
authors.initials: SG
authors.lastname: Chen
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Niann-Tzyy
authors.initials: NT
authors.lastname: Dai
authors.affiliation: Division of Traumatic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Cheng-Jung
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Department of Anesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Jia-Lin
authors.initials: JL
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taoyuan Armed Forces General Hospital, National Defense Medical Center, Taoyuan, Taiwan. Electronic address: sung1500@mail.ndmctsgh.edu.tw.
authors.forename: Chien-Sung
authors.initials: CS
authors.lastname: Tsai
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000628:therapy*; D002059:Burns, Inhalation / Q000150:complications / Q000628:therapy*; D003646:Debridement; D005107:Explosions; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000209:etiology; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D015996:Survival Rate; D013624:Taiwan; D015599:Trauma Severity Indices
keywords: Acute respiratory distress syndrome; Explosion injury; Extracorporeal membrane oxygenation; Major burn