Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support
Ismael A. Salas de Armas, Bindu Akkanti, Pratik Doshi, Manish Kumar Patel, Sachin Kumar, Mehmet H. Akay, Rahat Hussain, Kha Dinh, Muhammad Yasir Baloch, Mahmoud Ahmed, Igor Banjac, Marwan Jumean, Kelly McGinness, Lisa Janowiak, Kriti Mittal Agrawal, Sriram Nathan, John Zaki, Luis Nieto, Kimberly Klein, Ethan Taub, Hlaing Tint, Jayeshkumar Patel, Angelo Nascimbene, Biswajit Kar, Igor D. Gregorič
Abstract
BACKGROUND: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. STUDY DESIGN: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. RESULTS: ratio was 53.0 (IQR, 27.0-76.0), median injury severity score was 34.0 (IQR, 27.0-43.0), and the median duration of ECMO support was 11 days (IQR, 7.5-20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). CONCLUSIONS: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.