Medical and Surgical Critical Care Department, Cardiac Surgery, University of Florence, Florence, Italy.
J Thorac Cardiovasc Surg. 2013 Jun;145(6):1617-26. doi: 10.1016/j.jtcvs.2012.08.046. Epub 2012 Sep 13.
Major trauma is a leading cause of death, particularly among young patients. New strategies in management are needed to improve poor outcomes in cases of severe trauma. Extracorporeal life support (ECLS) has proven to be effective in acute cardiopulmonary failure of different causes, even when conventional therapies fail. We report our initial experience with ECLS as a rescue therapy in severely polytraumatized patients in a refractory clinical setting. This study identifies the pre-ECLS characteristics of patients to predict the appropriateness of ECLS treatment.
From December 2008 to May 2012, 375 patients with polytrauma were treated in the Careggi Teaching Hospital, a tertiary-level referral trauma center. Our ECLS team was alerted on 30 patients and applied ECLS in 18 adult patients with trauma. We adopted venoarterial ECLS in 14 patients with cardiopulmonary failure with refractory shock and venovenous ECLS in 4 patients with isolated refractory acute respiratory failure.
ECLS was initiated at a mean of 359.176 ± 216.606 (145-950) minutes from trauma. In 4 patients, the ECLS treatment failed because of an incapability to maintain adequate ECLS flow and perfusion. In 14 patients, efficiently supported by ECLS, the cardiac index, mean arterial pressure, blood lactate concentration, arterial oxygen tension, arterial carbon dioxide tension, and pH showed significant improvement, with normal values reached at 3.5 ± 1.5 hours.
From our data, ECLS seems to be a valuable option to resuscitate patients with severe trauma when conventional therapies are insufficient. ECLS is safe, feasible, and effective in providing hemodynamic support and blood gas exchange.
严重创伤是导致死亡的主要原因，尤其是在年轻患者中。需要新的管理策略来改善严重创伤患者的不良预后。体外生命支持（ECLS）已被证明对不同原因的急性心肺衰竭有效，即使在常规治疗失败的情况下也是如此。我们报告了我们在难治性临床情况下使用 ECLS 作为严重多发伤患者的抢救治疗的初步经验。本研究确定了 ECLS 治疗前患者的特征，以预测 ECLS 治疗的适宜性。
从 2008 年 12 月至 2012 年 5 月，375 名多发伤患者在三级转诊创伤中心 Careggi 教学医院接受治疗。我们的 ECLS 小组对 30 名患者发出警报，并对 18 名创伤成年患者应用了 ECLS。我们对 14 名心肺衰竭伴难治性休克的患者采用了静脉动脉 ECLS，对 4 名孤立性难治性急性呼吸衰竭的患者采用了静脉静脉 ECLS。
ECLS 从创伤开始平均启动时间为 359.176±216.606（145-950）分钟。在 4 名患者中，ECLS 治疗因无法维持足够的 ECLS 流量和灌注而失败。在 14 名患者中，ECLS 有效支持下，心指数、平均动脉压、血乳酸浓度、动脉氧分压、动脉二氧化碳分压和 pH 值显著改善，在 3.5±1.5 小时内达到正常值。
根据我们的数据，当常规治疗不足时，ECLS 似乎是抢救严重创伤患者的一种有价值的选择。ECLS 安全、可行且有效，可提供血流动力学支持和血气交换。
