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Extracorporeal Membrane Oxygenation in the Unstable Trauma Patient

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Endovascular Resuscitation and Trauma Management

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

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Abstract

Extracorporeal membrane oxygenation (ECMO) provides mechanical support for either (1) the heart and lungs, termed venoarterial (VA) ECMO or (2) the lungs alone, termed venovenous (VV) ECMO. This chapter will focus primarily on the application of VV ECMO in the trauma patient, but will also briefly touch upon the relatively new use of VA ECMO in this population. Basic tenets of circuitry, cannulation strategies, and management will be reviewed.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Emily J. MacKay

  2. Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Jeremy W. Cannon

  3. Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Jeremy W. Cannon

Authors
  1. Emily J. MacKay
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  2. Jeremy W. Cannon
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Corresponding author

Correspondence to Jeremy W. Cannon .

Editor information

Editors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden

    Tal Hörer

  2. University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    Joseph J. DuBose

  3. F. Edward Hebert School of Medicine – “America’s Medical School”, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Todd E. Rasmussen

  4. The Department of Surgery at Uniformed Services, University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, USA

    Joseph M. White

Experts’ Comments by Emiliano Gamberini and Alessandro Circelli

Experts’ Comments by Emiliano Gamberini and Alessandro Circelli

There has been a significant increase in the use of extracorporeal life support (ECLS) in adult patients who are in a state of shock and pulmonary failure. It has been proven to be effective and safe in acute cardiopulmonary failure, even when conventional therapies fail. Advanced management of polytrauma patients should include extracorporeal membrane oxygenation (ECMO) in cases of persistent circulatory and/or respiratory failure despite adequate conventional treatments [30, 60, 61].

Technical advances and compact devices have led to the increased use of ECLS as an advanced option in severe trauma treatment. The improvements in devices allow safer and easier ECLS, for example, anticoagulation can be safely delayed for 48–72 h after trauma due to improved biocompatibility.

ECMO can be used in severe multiple trauma patients as a multi-approach management in respiratory failure (lung contusions, chest wall disruption, acute respiratory distress syndrome), traumatic brain injury (TBI) with associated respiratory failure and impossibility of maintaining normo-hypocapnia with lung protective strategies, post-traumatic cardiogenic shock (providing full hemodynamic support), and tracheobronchial injury.

In patients with severe TBI and hemodynamic instability, ECLS can be used with the purpose of saving time for brain death assessment, and should be continued in order to support an eventual organ donation program.

ECMO is also used to ensure adequate perfusion in cardiopulmonary failure in patients with severe trauma, even in the context of hemorrhagic shock. The surgeon can perform damage control surgery, and coagulation abnormalities can be treated according to the recommendations for blood component transfusion.

ECLS is also used in post-traumatic cardiac arrest requiring resuscitative thoracotomy, but the evidence for this is still inadequate.

The evidence for the benefits in terms of survival is still lacking, although we think that ECLS plays an important role in trauma patients, although the exact role is yet unknown. The use of ECMO in the treatment of trauma patients should be considered in patient populations where conventional treatments fail to result in more benefits than risks.

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MacKay, E.J., Cannon, J.W. (2020). Extracorporeal Membrane Oxygenation in the Unstable Trauma Patient. In: Hörer, T., DuBose, J., Rasmussen, T., White, J. (eds) Endovascular Resuscitation and Trauma Management . Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-25341-7_15

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