BACKGROUND: Venovenous extracorporeal membrane oxygenation (vv-ECMO) is an established salvage therapy for severe respiratory failure, and may provide an alternative form of treatment for trauma-induced adult respiratory distress syndrome (ARDS) when conven tional treatments have failed. The need for systemic anticoagulation is a relative contraindication for patients with bleeding risks, especially in multitraumatic injury. METHODS: We describe a case series of four trauma patients with ARDS who were managed with ECMO admitted to the neuro critical care unit at Addenbrooke’s Hospital, Cambridge (UK), from January 2000 to January 2016. We performed a systematic review of the available literature to investigate the safety and efficacy of vv-ECMO in posttraumatic ARDS, focusing on the use of different an ticoagulation strategies and risk of bleeding on patients with multiple injuries. RESULTS: Thirty-one patients were included. A heparin bolus was given in 16 cases. Eleven patients developed complications during treatment with ECMO with three cases of major bleeding. In all documented cases of bleeding a bolus and infusion of heparin was admin istered, aiming for an activated clotting time (ACT) target longer than 150 seconds. Two patients treated with heparin-free ECMO developed thromboembolic complications. Four patients died, and death was never directly or indirectly related to use of ECMO. CONCLUSION: vv-ECMO can be lifesaving in respiratory failure. Our experience and our literature review suggest that vv-ECMO should be con sidered as a rescue treatment for the management of severe hypoxemic respiratory failure secondary to ARDS in trauma patients. For patients with a high risk of bleeding, the use of ECMO with no initial anticoagulation could be considered a valid option. For patients with a moderate risk of bleeding, use of a heparin infusion keeping an ACT target shorter than 150 seconds can be appro priate. (J Trauma Acute Care Surg. 2017;82: 165–173. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.) LEVEL OF EVIDENCE: Therapeutic study, level V. KEY WORDS: Adult respiratory distress syndrome; extracorporeal membrane oxygenation; hypoxemic respiratory failure; trauma

Extracorporeal membrane oxygenation for acute respiratory distress syndrome in trauma patients: a case series and systematic literature review / Robba, C; Ortu, A; Bilotta, F; Lombardo, A; Sekhon, Ms; Gallo, F; Matta, B. - In: THE JOURNAL OF TRAUMA AND ACUTE CARE SURGERY. - ISSN 2163-0755. - (2016).

Extracorporeal membrane oxygenation for acute respiratory distress syndrome in trauma patients: a case series and systematic literature review

Bilotta F;
2016

Abstract

BACKGROUND: Venovenous extracorporeal membrane oxygenation (vv-ECMO) is an established salvage therapy for severe respiratory failure, and may provide an alternative form of treatment for trauma-induced adult respiratory distress syndrome (ARDS) when conven tional treatments have failed. The need for systemic anticoagulation is a relative contraindication for patients with bleeding risks, especially in multitraumatic injury. METHODS: We describe a case series of four trauma patients with ARDS who were managed with ECMO admitted to the neuro critical care unit at Addenbrooke’s Hospital, Cambridge (UK), from January 2000 to January 2016. We performed a systematic review of the available literature to investigate the safety and efficacy of vv-ECMO in posttraumatic ARDS, focusing on the use of different an ticoagulation strategies and risk of bleeding on patients with multiple injuries. RESULTS: Thirty-one patients were included. A heparin bolus was given in 16 cases. Eleven patients developed complications during treatment with ECMO with three cases of major bleeding. In all documented cases of bleeding a bolus and infusion of heparin was admin istered, aiming for an activated clotting time (ACT) target longer than 150 seconds. Two patients treated with heparin-free ECMO developed thromboembolic complications. Four patients died, and death was never directly or indirectly related to use of ECMO. CONCLUSION: vv-ECMO can be lifesaving in respiratory failure. Our experience and our literature review suggest that vv-ECMO should be con sidered as a rescue treatment for the management of severe hypoxemic respiratory failure secondary to ARDS in trauma patients. For patients with a high risk of bleeding, the use of ECMO with no initial anticoagulation could be considered a valid option. For patients with a moderate risk of bleeding, use of a heparin infusion keeping an ACT target shorter than 150 seconds can be appro priate. (J Trauma Acute Care Surg. 2017;82: 165–173. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.) LEVEL OF EVIDENCE: Therapeutic study, level V. KEY WORDS: Adult respiratory distress syndrome; extracorporeal membrane oxygenation; hypoxemic respiratory failure; trauma
2016
extracorporeal membrane oxygenation; acute respiratory distress syndrome; trauma patients
01 Pubblicazione su rivista::01g Articolo di rassegna (Review)
Extracorporeal membrane oxygenation for acute respiratory distress syndrome in trauma patients: a case series and systematic literature review / Robba, C; Ortu, A; Bilotta, F; Lombardo, A; Sekhon, Ms; Gallo, F; Matta, B. - In: THE JOURNAL OF TRAUMA AND ACUTE CARE SURGERY. - ISSN 2163-0755. - (2016).
File allegati a questo prodotto
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1656888
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 27
  • ???jsp.display-item.citation.isi??? ND
social impact