Nosanov Lauren B, McLawhorn Melissa M, Vigiola Cruz Mariana, Chen Jason H, Shupp Jeffrey W
Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC.
J Burn Care Res. 2017 Dec 27;39(1):10-14. doi: 10.1097/BCR.0000000000000555.
Extracorporeal membranous oxygenation (ECMO) has become an increasingly utilized used strategy to support patients in cardiac and cardiopulmonary failure. The Extracorporeal Life Support Organization reports adult survival rates between 40 and 50%. Utilization Use and outcomes for burned patients undergoing ECMO are poorly understood. The National Burn Repository (version 8.0) was queried for patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) procedure codes for ECMO. Demographics, comorbidities, mechanism, injury details, and clinical outcomes were recorded. ECMO patients were matched one-to-one to those not requiring ECMO based on age, gender, TBSA, and inhalation injury. Group comparisons were made utilizing using χ2 and Mann-Whitney U tests. Thirty ECMO-treated burn patients were identified. Patients were predominantly male (80.0%) and Caucasian (63.3%) with mean age 38.9 ± 20.3 years. The majority were flame injuries (80.0%) of moderate size (17.0 ± 18.7% TBSA), affecting predominantly upper limbs and trunk. Inhalation injury was reported in 26.7%. Respiratory failure was reported in nine, acute respiratory distress syndrome in three, and pneumonia in nine. Fourteen patients survived to discharge. The ECMO cohort had significantly higher rates of cardiovascular comorbidities, concomitant major thoracic trauma, pneumonia, acute renal failure, and sepsis than non-ECMO patients (P < .05). Ventilator usage, intesive care unit (ICU) length of stay, and mortality were also significantly higher in those treated by ECMO (P < .05). Although burn patients placed on ECMO have significantly higher rates of morbidity and mortality than those not requiring ECMO, the mortality rate is equivalent to patients reported by Extracorporeal Life Support Organization. ECMO is a viable option for supporting critically injured burn patients.
体外膜肺氧合（ECMO）已成为支持心脏和心肺功能衰竭患者的一种越来越常用的策略。体外生命支持组织报告称成人存活率在40%至50%之间。对于接受ECMO治疗的烧伤患者，其使用情况和治疗结果尚不清楚。我们查询了国家烧伤资料库（第8.0版）中具有国际疾病分类第九版临床修订本（ICD - 9）ECMO手术编码的患者。记录了人口统计学信息、合并症、受伤机制、损伤细节和临床结果。根据年龄、性别、烧伤总面积（TBSA）和吸入性损伤情况，将接受ECMO治疗的患者与不需要ECMO治疗的患者进行一对一匹配。采用χ2检验和曼 - 惠特尼U检验进行组间比较。共确定了30例接受ECMO治疗的烧伤患者。患者以男性为主（80.0%），白种人（63.3%），平均年龄38.9±20.3岁。大多数为中度面积（17.0±18.7%TBSA）的火焰烧伤（80.0%），主要影响上肢和躯干。26.7%的患者报告有吸入性损伤。9例患者出现呼吸衰竭，3例出现急性呼吸窘迫综合征，9例出现肺炎。14例患者存活出院。与非ECMO患者相比，ECMO组患者心血管合并症、伴有严重胸部创伤、肺炎、急性肾衰竭和败血症的发生率显著更高（P < 0.05）。接受ECMO治疗的患者呼吸机使用时间、重症监护病房（ICU）住院时间和死亡率也显著更高（P < 0.05）。虽然接受ECMO治疗的烧伤患者的发病率和死亡率明显高于不需要ECMO治疗的患者，但其死亡率与体外生命支持组织报告的患者相当。ECMO是支持严重烧伤患者的一种可行选择。
