Extracorporeal life support in post-traumatic respiratory distress patients☆

Abstract 

Background

Extracorporeal life support (ECLS) has been applied successfully to patients with acute cardiopulmonary failure. However, ECLS remains controversial for traumatized patients who are prone to bleeding.

Patients and methods

From March 2004 to October 2007, nine patients with post-traumatic respiratory distress refractory to ventilator support were treated with ECLS. Mean patient age was 35.1±9.7 (range, 18–47) years, average injury severity score (ISS) was 44.56±4.93 (range, 35–50), and Sequential Organ Failure Assessment score (SOFA) score was 12.1±3.67 (range, 7–16). Before ECLS, all patients had received thoracic interventions, including four lung resections, with a mean PaO₂ of 49.04±9.82 (range, 31–64) mmHg and PaCO₂ of 66.4±15.72 (range, 45–86) mmHg. Seven patients were supported in standard veno-venous mode, and the other two were initially supported in veno-arterial mode due to hemodynamic instability.

Results

Median interval from trauma to ECLS was 33 (range, 4–384) h, and median duration of ECLS was 145 (range, 69–456) h. Six (66.7%) patients received additional surgeries during ECLS. One died of sepsis from occult colon rupture and the other of acute liver failure, 6 and 13 days respectively after trauma. Seven (77.8%) patients were weaned and discharged.

Conclusions

Using ECLS to resuscitate traumatic respiratory distress proved to be safe and effective when conventional therapies had been exhausted. Early deployment of ECLS to preserve systemic organ perfusion, aggressive treatment of coexisting injuries and tailored anticoagulation protocols are crucial to a successful outcome.

Keywords: Extracorporeal life support, Respiratory distress, Trauma, ECLS, ISS