Ried Michael, Bein Thomas, Philipp Alois, Müller Thomas, Graf Bernhard, Schmid Christof, Zonies David, Diez Claudius, Hofmann Hans-Stefan
Crit Care. 2013 Jun 20;17(3):R110. doi: 10.1186/cc12782.
Severe trauma with concomitant chest injury is frequently associated with acute lung failure (ALF). This report summarizes our experience with extracorporeal lung support (ELS) in thoracic trauma patients treated at the University Medical Center Regensburg.
A retrospective, observational analysis of prospectively collected data (Regensburg ECMO Registry database) was performed for all consecutive trauma patients with acute pulmonary failure requiring ELS during a 10-year interval.
Between April 2002 and April 2012, 52 patients (49 male, three female) with severe thoracic trauma and ALF refractory to conventional therapy required ELS. The mean age was 32±14 years (range, 16 to 72 years). Major traffic accident (73%) was the most common trauma, followed by blast injury (17%), deep fall (8%) and blunt trauma (2%). The mean Injury Severity Score was 58.9±10.5, the mean lung injury score was 3.3±0.6 and the Sequential Organ Failure Assessment score was 10.5±3. Twenty-six patients required pumpless extracorporeal lung assist (PECLA) and 26 patients required veno-venous extracorporeal membrane oxygenation (vv-ECMO) for primary post-traumatic respiratory failure. The mean time to ELS support was 5.2±7.7 days (range, <24 hours to 38 days) and the mean ELS duration was 6.9±3.6 days (range, <24 hours to 19 days). In 24 cases (48%) ELS implantation was performed in an external facility, and cannulation was done percutaneously by Seldinger's technique in 98% of patients. Cannula-related complications occurred in 15% of patients (PECLA, 19% (n=5); vv-ECMO, 12% (n=3)). Surgery was performed in 44 patients, with 16 patients under ELS prevention. Eight patients (15%) died during ELS support and three patients (6%) died after ELS weaning. The overall survival rate was 79% compared with the proposed Injury Severity Score-related mortality (59%).
Pumpless and pump-driven ELS systems are an excellent treatment option in severe thoracic trauma patients with ALF and facilitate survival in an experienced trauma center with an interdisciplinary treatment approach. We encourage the use of vv-ECMO due to reduced complication rates, better oxygenation and best short-term outcome.
严重创伤合并胸部损伤常与急性肺衰竭（ALF）相关。本报告总结了我们在雷根斯堡大学医学中心治疗的胸部创伤患者中应用体外肺支持（ELS）的经验。
对前瞻性收集的数据（雷根斯堡体外膜肺氧合登记数据库）进行回顾性观察分析，纳入10年间所有因急性肺衰竭需要ELS的连续性创伤患者。
2002年4月至2012年4月，52例（49例男性，3例女性）严重胸部创伤且常规治疗难治的ALF患者需要ELS。平均年龄为32±14岁（范围16至72岁）。主要交通事故（73%）是最常见的创伤类型，其次是爆炸伤（17%）、高处坠落（8%）和钝性创伤（2%）。平均损伤严重度评分是58.9±10.5，平均肺损伤评分是3.3±0.6，序贯器官衰竭评估评分是10.5±3。26例患者需要无泵体外肺辅助（PECLA），26例患者因创伤后原发性呼吸衰竭需要静脉-静脉体外膜肺氧合（vv-ECMO）。ELS支持的平均时间是5.2±7.7天（范围<24小时至38天），平均ELS持续时间是6.9±3.6天（范围<24小时至19天）。24例（48%）患者在外部机构进行ELS植入，98%的患者通过Seldinger技术经皮插管。15%的患者发生插管相关并发症（PECLA，19%（n = 5）；vv-ECMO，12%（n = 3））。44例患者接受手术，其中16例在ELS支持下进行。8例（15%）患者在ELS支持期间死亡，3例（6%）患者在ELS撤机后死亡。总体生存率为79%，而根据损伤严重度评分预计的死亡率为59%。
无泵和有泵驱动的ELS系统是治疗严重胸部创伤合并ALF患者的极佳选择，在经验丰富的创伤中心采用多学科治疗方法可提高生存率。由于并发症发生率较低、氧合效果更好且短期预后最佳，我们鼓励使用vv-ECMO。
