Department of Cardiothoracic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
Scand J Trauma Resusc Emerg Med. 2018 Feb 8;26(1):14. doi: 10.1186/s13049-018-0481-6.
Using extracorporeal membrane oxygenation (ECMO) to provide advanced life support in adult trauma patients remains a controversial issue now. The study was aimed at identifying the independent predictors of hospital mortality in adult trauma patients receiving ECMO for advanced cardiopulmonary dysfunctions.
This retrospective study enrolled 36 adult trauma patients receiving ECMO due to advanced shock or respiratory failure in a level I trauma center between August 2006 and October 2014. Variables collected for analysis were demographics, serum biomarkers, characteristics of trauma, injury severity score (ISS), damage-control interventions, indications of ECMO, and associated complications. The outcomes were hospital mortality and hemorrhage on ECMO. The multivariate logistic regression method was used to identify the independent prognostic predictors for the outcomes.
The medians of age and ISS were 36 (27-49) years and 29 (19-45). Twenty-three patients received damage-control interventions before ECMO. Among the 36 trauma patients, 14 received ECMO due to shock and 22 for respiratory failure. The complications of ECMO are major hemorrhages (n = 12), acute renal failure requiring hemodialysis (n = 10), and major brain events (n = 7). There were 15 patients died in hospital, and 9 of them were in the shock group.
The severity of trauma and the type of cardiopulmonary dysfunction significantly affected the outcomes of ECMO used for sustaining patients with post-traumatic cardiopulmonary dysfunction. Hemorrhage on ECMO remained a concern while the device was required soon after trauma, although a heparin-minimized protocol was adopted.
This study reported a health care intervention on human participants and was retrospectively registered. The Chang Gung Medical Foundation Institutional Review Board approved the study (no. 201601610B0) on December 12, 2016. All of the data were extracted from December 14, 2016, to March 31, 2017.
在成人创伤患者中使用体外膜肺氧合（ECMO）来提供高级生命支持仍然是一个有争议的问题。本研究旨在确定接受 ECMO 治疗的成人创伤患者因心、肺功能障碍而住院死亡的独立预测因素。
本回顾性研究纳入了 2006 年 8 月至 2014 年 10 月期间在一级创伤中心因严重休克或呼吸衰竭而接受 ECMO 的 36 例成人创伤患者。分析时收集的变量包括人口统计学、血清生物标志物、创伤特征、损伤严重程度评分（ISS）、控制性损伤干预、ECMO 适应证和相关并发症。结局为住院死亡率和 ECMO 期间出血。采用多变量逻辑回归方法确定结局的独立预后预测因素。
年龄和 ISS 的中位数分别为 36（27-49）岁和 29（19-45）分。23 例患者在接受 ECMO 前接受了控制性损伤干预。在 36 例创伤患者中，14 例因休克而接受 ECMO，22 例因呼吸衰竭而接受 ECMO。ECMO 的并发症包括大出血（n=12）、需要血液透析的急性肾衰竭（n=10）和重大脑事件（n=7）。有 15 例患者在医院死亡，其中 9 例在休克组。
创伤严重程度和心肺功能障碍的类型显著影响 ECMO 治疗创伤后心肺功能障碍患者的结局。尽管采用了肝素最小化方案，但 ECMO 期间仍存在出血问题，并且在创伤后不久就需要使用该设备。
本研究报告了一项针对人类参与者的医疗干预措施，并进行了回顾性注册。2016 年 12 月 12 日，长庚医疗基金会伦理委员会批准了该研究（编号 201601610B0）。所有数据均于 2016 年 12 月 14 日至 2017 年 3 月 31 日提取。
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