Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
Resuscitation. 2010 Jul;81(7):804-9. doi: 10.1016/j.resuscitation.2010.02.020. Epub 2010 Apr 7.
Death to trauma is caused by disastrous injuries on scene, bleeding shock or acute respiratory failure (ARDS) induced by trauma and massive blood transfusion. Extracorporeal membrane oxygenation (ECMO) can be effective in severe cardiopulmonary failure, but preexisting bleeding is still a contraindication for its use. We report our first experiences in application of initially heparin-free ECMO in severe trauma patients with resistant cardiopulmonary failure and coexisting bleeding shock retrospectively and describe blood coagulation management on ECMO.
From June 2006 to June 2009 we treated adult trauma patients (n=10, mean age: 32+/-14 years, mean ISS score 73+/-4) with percutaneous veno-venous (v-v) ECMO for pulmonary failure (n=7) and with veno-arterial (v-a) ECMO in cardiopulmonary failure (n=3). Diagnosis included polytrauma (n=9) and open chest trauma (n=1). We used a new miniaturised ECMO device (PLS-Set, MAQUET Cardiopulmonary AG, Hechingen, Germany) and performed initially heparin-free ECMO.
Prior to ECMO median oxygenation ratio (OR) was 47 (36-90) mmHg, median paCO(2) was 67 (36-89) mmHg and median norepinephrine demand was 3.0 (1.0-13.5) mg/h. Cardiopulmonary failure was treated effectively with ECMO and systemic gas exchange and blood flow improved rapidly within 2 h on ECMO in all patients (median OR 69 (52-263) mmHg, median paCO(2) 41 (22-85) mmHg. 60% of our patients had recovered completely.
Initially heparin-free ECMO support can improve therapy and outcome even in disastrous trauma patients with coexisting bleeding shock.
创伤死亡是由于现场灾难性损伤、出血性休克或创伤和大量输血引起的急性呼吸衰竭（ARDS）所致。体外膜肺氧合（ECMO）可有效治疗严重心肺衰竭，但预先存在的出血仍然是其使用的禁忌症。我们回顾性报告了我们在严重创伤患者中首次应用最初无肝素 ECMO 的经验，这些患者存在难治性心肺衰竭和合并出血性休克，并描述了 ECMO 上的凝血管理。
从 2006 年 6 月至 2009 年 6 月，我们使用经皮静脉-静脉（v-v）ECMO 治疗了 7 例肺衰竭和 3 例心肺衰竭的成年创伤患者（平均年龄：32+/-14 岁，平均 ISS 评分 73+/-4）。诊断包括多发伤（n=9）和开放性胸部创伤（n=1）。我们使用了一种新型微型 ECMO 装置（PLS-Set，MAQUET Cardiopulmonary AG，Hechingen，德国），并进行了最初无肝素的 ECMO。
在 ECMO 之前，中位数氧合比（OR）为 47（36-90）mmHg，中位数 paCO（2）为 67（36-89）mmHg，中位数去甲肾上腺素需求量为 3.0（1.0-13.5）mg/h。所有患者的 ECMO 治疗均有效，心肺衰竭得到有效治疗，全身气体交换和血流在 ECMO 上 2 小时内迅速改善（中位数 OR 69（52-263）mmHg，中位数 paCO（2）为 41（22-85）mmHg。我们有 60%的患者完全康复。
最初无肝素的 ECMO 支持即使在合并出血性休克的灾难性创伤患者中也可以改善治疗和预后。
