Hsu Po-Shun, Tsai Yi-Ting, Lin Chih-Yuan, Chen Shyi-Gen, Dai Niann-Tzyy, Chen Cheng-Jung, Chen Jia-Lin, Tsai Chien-Sung
Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Burns. 2017 May;43(3):674-680. doi: 10.1016/j.burns.2016.08.035. Epub 2016 Dec 28.
Explosion injury is very common on the battlefield and is associated with major burn and inhalation injuries and subsequent high mortality and morbidity rates. Here we report six victims who suffered from explosion injuries caused by stun grenade; all were treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy. This study was aimed to evaluate the indications and efficacy of ECMO in acute and critically ill major burn patients.
This was a retrospective analysis of six patients from Tri-Service General Hospital, National Defense Medical Center in Taiwan. All suffered from major burns with 89.0±19.1% average of total body surface area over second degree (TBSA; range, 50-99%). ECMO was used due to inhalation injury in five patients and cardiogenic shock in one patient. The average interval to start ECMO was 26.5±19.0h (range, 14-63h). Venoarterial ECMO was used on in four patients due to unstable hemodynamic status, whereas venovenous ECMO was used in two patients for sustained hypoxemia.
All patients had rhabdomyolysis with acute renal failure. The average duration of ECMO was 169.6±180.9h (range, 27-401h). All patients developed coagulopathy and needed debridement surgery during ECMO support, and five underwent torso escharotomy due to inspiratory compromise. Only one patient whose second and third degree burns covered 50% TBSA was successfully weaned from ECMO and survived; he was discharged after 221 hospital days. All patients who died had second and third degree burns covering over 90% of their TBSA. Three patients died of multiple organ failure, one died of septic shock, and the other died of cardiogenic shock. Overall survival rate was 16.7%.
In acute and critically ill major burn patients, ECMO could be considered as a salvage therapy, particularly in those with inhalation injury and burn-related acute respiratory distress syndrome. However, ECMO does not seem to provide benefits for circulatory support in those with hemodynamic compromise. The use of ECMO in these patients is still investigational, as our data provided no benefit in terms of the outcomes or survival, particularly in those with more than 90% TBSA burns.
爆炸伤在战场上非常常见，常伴有严重烧伤和吸入性损伤，进而导致高死亡率和高发病率。在此，我们报告6例因眩晕手榴弹爆炸受伤的患者；所有患者均接受体外膜肺氧合（ECMO）作为挽救治疗。本研究旨在评估ECMO在急性重症大面积烧伤患者中的适应证及疗效。
这是一项对台湾国防医学中心三军总医院6例患者的回顾性分析。所有患者均为大面积烧伤，平均二度以上烧伤总面积为89.0±19.1%（范围为50-99%）。5例患者因吸入性损伤、1例患者因心源性休克接受ECMO治疗。开始ECMO的平均间隔时间为26.5±19.0小时（范围为14-63小时）。4例患者因血流动力学不稳定采用静脉-动脉ECMO，2例患者因持续性低氧血症采用静脉-静脉ECMO。
所有患者均发生横纹肌溶解伴急性肾衰竭。ECMO的平均持续时间为169.6±180.9小时（范围为27-401小时）。所有患者在ECMO支持期间均出现凝血功能障碍，且需要进行清创手术，5例患者因吸气功能受限接受了躯干焦痂切开术。仅1例二度和三度烧伤面积占体表面积50%的患者成功脱离ECMO并存活；他在住院221天后出院。所有死亡患者的二度和三度烧伤面积均超过体表面积的90%。3例患者死于多器官功能衰竭，1例死于感染性休克，另1例死于心源性休克。总体生存率为16.7%。
在急性重症大面积烧伤患者中，可考虑将ECMO作为挽救治疗方法，尤其是对于伴有吸入性损伤和烧伤相关急性呼吸窘迫综合征的患者。然而，对于血流动力学受损的患者，ECMO似乎并不能为循环支持带来益处。在这些患者中使用ECMO仍处于研究阶段，因为我们的数据在结局或生存率方面并未显示出益处，尤其是对于烧伤面积超过体表面积90%的患者。
