Darocha Tomasz, Kosiński Sylweriusz, Jarosz Anna, Drwila Rafal
From the Department of Anesthesiology and Intensive Care, John Paul II Hospital, Collegium Medicum, Jagiellonian University, Cracow, Poland (TD, AJ, RD) and Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland (SK).
Medicine (Baltimore). 2015 Jul;94(27):e1086. doi: 10.1097/MD.0000000000001086.
The use of extracorporeal membrane oxygenation is a new approach to rewarming patients with severe hypothermia and hemodynamic instability. There are, however, many questions regarding qualification for this technique in case of suspected or confirmed trauma.A male with confirmed accidental hypothermia (25°C) and after successful cardiopulmonary resuscitation from in-hospital cardiac arrest was subjected to a protocol of extracorporeal rewarming from profound hypothermia. Because of unclear history, a full trauma computed tomography was performed that showed pericerebral hematoma and signs of previously undergone right craniotomy, multiple right-sided rib fractures and the presence of intraperitoneal fluid. Based on repeated imaging and specialist consultation, no life-threatening injuries were identified and rewarming with extracorporeal membrane oxygenation was safely performed. In a year follow-up, the patient was found to be alive, with no neurologic deficits.Although this case highlights the first successful utilization of extracorporeal rewarming in a trauma patient at our center there are several limitations to its widespread use.
体外膜肺氧合的应用是一种用于复温严重体温过低且伴有血流动力学不稳定患者的新方法。然而,对于疑似或确诊创伤患者应用该技术的适应证仍存在诸多问题。一名确诊意外体温过低(25°C)且在医院心脏骤停后成功进行心肺复苏的男性患者,接受了从深度低温进行体外复温的方案。由于病史不明,进行了全面的创伤计算机断层扫描,结果显示脑周血肿以及既往右侧开颅手术的迹象、右侧多发肋骨骨折和腹腔内积液。基于反复成像和专家会诊,未发现危及生命的损伤,并安全地进行了体外膜肺氧合复温。在一年的随访中,发现该患者存活,无神经功能缺损。尽管该病例凸显了我们中心首次成功地在创伤患者中应用体外复温,但广泛应用仍存在若干限制。