体外膜肺氧合在难治性创伤相关严重急性呼吸窘迫综合征管理中的应用：东部创伤外科学会全国调查
Use of extracorporeal membranous oxygenation in the management of refractory trauma-related severe acute respiratory distress syndrome: a national survey of the Eastern Association for the Surgery of Trauma.
作者信息
Raff Lauren, Kerby Jeffrey David, Reiff Donald, Jansen Jan, Schinnerer Eric, McGwin Gerald, Bosarge Patrick
机构信息
Trauma and Acute Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
出版信息
Trauma Surg Acute Care Open. 2019 Aug 12;4(1):e000341. doi: 10.1136/tsaco-2019-000341. eCollection 2019.
OBJECTIVE
To report results of a national survey of provider attitudes, observations, and opinions regarding the use of extracorporeal membranous oxygenation (ECMO) to manage severe acute respiratory distress syndrome (ARDS) in trauma patients.
DESIGN
A survey was created to query providers on the use of ECMO in trauma, as well as general management principals related to care of the patient with refractory hypoxic respiratory failure. The survey was sent to all members of Eastern Association for the Surgery of Trauma (EAST). Once completed, the survey was returned to the University of Alabama at Birmingham and results were analyzed.
SETTING/PATIENTS: Trauma patients with refractory ARDS.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Respondents were from 37 states, the District of Columbia, and Puerto Rico. 56.9% reported institutional ECMO capabilities, but only 45.2% reported using ECMO for trauma patients. Most respondents (90.2%) reported ECMO use in less than or equal to five trauma patients per year. 20.9% think there is not enough data to support its use in trauma but only 4.7% would absolutely not consider ECMO use for trauma patients. Ranking the preferred modality of treatments for refractory ARDS from most to least preferable is as follows: airway pressure release ventilation, bilevel ventilation, paralysis, prone positioning, inhaled nitric oxide, epoprostenol, high-frequency oscillatory ventilation, corticosteroids, surfactant.
CONCLUSIONS
ARDS has a high mortality among trauma patients. Despite its utility in treating severe ARDS and other pulmonary disease processes, ECMO has not been universally embraced by the trauma community. There are an increasing number of studies that suggest that ECMO is a safe and viable treatment option for trauma patients with ARDS. Based on the results of this survey, ECMO use remains limited by trauma providers that care for patients with refractory hypoxic respiratory failure and ARDS, likely due to a combination of knowledge gaps and lack of access to ECMO.
LEVEL OF EVIDENCE
Level V.
目的
报告一项关于医疗服务提供者对使用体外膜肺氧合（ECMO）治疗创伤患者严重急性呼吸窘迫综合征（ARDS）的态度、观察结果及意见的全国性调查结果。
设计
创建了一项调查，以询问医疗服务提供者关于ECMO在创伤治疗中的使用情况，以及与难治性低氧性呼吸衰竭患者护理相关的一般管理原则。该调查发送给了东部创伤外科学会（EAST）的所有成员。调查完成后返回给阿拉巴马大学伯明翰分校并进行结果分析。
地点/患者：患有难治性ARDS的创伤患者。
干预措施
无。
测量指标及主要结果
受访者来自37个州、哥伦比亚特区和波多黎各。56.9%的人报告所在机构具备ECMO治疗能力，但只有45.2%的人报告使用ECMO治疗创伤患者。大多数受访者（90.2%）报告每年使用ECMO治疗的创伤患者少于或等于5例。20.9%的人认为没有足够的数据支持其在创伤治疗中的使用，但只有4.7%的人绝对不会考虑将ECMO用于创伤患者。将难治性ARDS的首选治疗方式按最优选到次优选排序如下：气道压力释放通气、双水平通气、麻痹、俯卧位、吸入一氧化氮、依前列醇、高频振荡通气、皮质类固醇、表面活性剂。
结论
ARDS在创伤患者中死亡率很高。尽管ECMO在治疗严重ARDS和其他肺部疾病过程中有用，但尚未被创伤领域广泛接受。越来越多的研究表明，ECMO是患有ARDS的创伤患者的一种安全可行的治疗选择。基于本次调查结果，ECMO的使用仍然受到为难治性低氧性呼吸衰竭和ARDS患者提供护理的创伤医疗服务提供者的限制，这可能是由于知识差距和无法获得ECMO的综合原因。
证据级别
V级。
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