Strumwasser Aaron, Tobin Joshua M, Henry Reynold, Guidry Chrissy, Park Caroline, Inaba Kenji, Demetriades Demetrios
1 Division of Trauma and Acute Care Surgery, Los Angeles County + USC Medical Center, Los Angeles, CA, USA.
2 Division of Trauma Anesthesiology, Keck School of Medicine of USC, Los Angeles County + USC Medical Center, Los Angeles, CA, USA.
Int J Artif Organs. 2018 Dec;41(12):845-853. doi: 10.1177/0391398818794111. Epub 2018 Aug 17.
: Limited options exist for cardiovascular support of the trauma patient in extremis. This patient population offers challenges that are often considered insurmountable. This article identifies a heterogeneous group of trauma patients in extremis who may benefit from extracorporeal membrane oxygenation.
: Data were sourced from the medical records of all patients placed on extracorporeal membrane oxygenation following trauma at a Level I Trauma Center between 1 December 2016 and 1 December 2017.
: All patients were male (N = 7), mostly with blunt injuries (n = 5), with an average age of 41 years and with an average Injury Severity Scores of 33 (median = 34). Two out of seven patients survived (28.5%). Survivors tended to have a longer duration on extracorporeal membrane oxygenation (13.5 vs 3.8 days), had extracorporeal membrane oxygenation initiated later (15 vs 7.8 days), and had suffered a blunt injury. Two patients were initiated on veno-arterial extracorporeal membrane oxygenation (both non-survivors) and five were initiated on veno-venous extracorporeal membrane oxygenation (two survivors, three non-survivors). Five patients were heparinized immediately (one survivor, four non-survivors), and two patients were heparinized after clotting was noted in the circuit (one survivor, one non-survivor). Three of the seven (42.8%) patients suffered cardiac arrest either prior to, or during, the initiation of extracorporeal membrane oxygenation (all non-survivors).
: Extracorporeal membrane oxygenation use in the trauma patient in extremis is not standard; however, this article demonstrates that extracorporeal membrane oxygenation is feasible in a complex, heterogeneous patient population when treated at designated centers.
对于处于危急状态的创伤患者，心血管支持的选择有限。这类患者群体面临着通常被认为无法克服的挑战。本文确定了一组处于危急状态的异质性创伤患者，他们可能从体外膜肺氧合中获益。
数据来源于2016年12月1日至2017年12月1日期间在一级创伤中心接受创伤后体外膜肺氧合治疗的所有患者的病历。
所有患者均为男性（N = 7），大多为钝性损伤（n = 5），平均年龄41岁，平均损伤严重程度评分为33分（中位数 = 34）。7名患者中有2名存活（28.5%）。存活者体外膜肺氧合的持续时间往往更长（13.5天对3.8天），体外膜肺氧合开始得更晚（15天对7.8天），且遭受钝性损伤。2名患者开始接受静脉 - 动脉体外膜肺氧合治疗（均未存活），5名患者开始接受静脉 - 静脉体外膜肺氧合治疗（2名存活，3名未存活）。5名患者立即接受肝素化治疗（1名存活，4名未存活），2名患者在回路中出现凝血后接受肝素化治疗（1名存活，1名未存活）。7名患者中有3名（42.8%）在体外膜肺氧合开始前或开始期间发生心脏骤停（均未存活）。
在处于危急状态的创伤患者中使用体外膜肺氧合并非标准治疗方法；然而，本文表明，在指定中心进行治疗时，体外膜肺氧合在复杂的异质性患者群体中是可行的。
