Emergency and Trauma Centre, The Alfred, Australia.
National Trauma Research Institute, Australia; Trauma Services, The Alfred, Australia; Breast, Endocrine and General Surgery (BES) Unit, The Alfred, Australia.
Injury. 2021 Sep;52(9):2515-2521. doi: 10.1016/j.injury.2021.03.058. Epub 2021 Apr 2.
Aim To review the indications, complications and outcomes of extracorporeal membrane oxygenation (ECMO) in major trauma patients. Methods Single centre, retrospective, cohort study. Results Over a ten year period, from 13,420 major trauma patients, 11 were identified from our institutional trauma registry as having received ECMO. These patients were predominantly younger (mean 39 +/- 17 years), male (91%) and severely traumatised (median ISS 50, IQR 34 - 54). Veno-venous (VV) ECMO was used predominantly (n = 7, 64%), to treat hypoxic respiratory failure (mean PaO2/FiO2 ratio 69.7 +/- 38.6), secondary to traumatic lung injury. Veno-arterial (VA) ECMO was used less frequently, primarily to treat massive pulmonary embolism following trauma. Major bleeding complications occurred in four patients, however only one patient died from haemorrhage. Heparin free (2/11), delayed (3/11) or low dose heparin (2/11) therapy was frequently utilised. The median time from injury to ECMO initiation was 1 day (IQR 0.5 - 5.5) and median ECMO duration 9 days (IQR 6.5 - 10.5). ECMO was initiated <72 hours in 6 patients, with survival to discharge 67%, compared to 20% in those initiated >72 hours. Overall survival to discharge was 45%, and was higher with VV ECMO (64%), than other configurations (25%). Conclusion ECMO was rarely used in major trauma, the most common indication being severe hypoxaemic respiratory failure secondary to lung injury. In this severely injured cohort, overall survival was poor but better in VV compared to VA and better if initiated early (<72 hours), compared to late.
回顾体外膜肺氧合（ECMO）在大型创伤患者中的适应证、并发症和结局。
单中心回顾性队列研究。
在十年期间，从我们机构的创伤登记处中确定了 11 名接受 ECMO 的创伤患者。这些患者主要为年轻患者（平均年龄 39 ± 17 岁）、男性（91%）和严重创伤患者（ISS 中位数 50，四分位距 34-54）。静脉-静脉（VV）ECMO 主要用于治疗创伤性肺损伤导致的低氧性呼吸衰竭（平均 PaO2/FiO2 比值 69.7 ± 38.6）。较少使用静脉-动脉（VA）ECMO，主要用于治疗创伤后大面积肺栓塞。4 名患者发生重大出血并发症，但仅 1 名患者因出血死亡。经常使用无肝素（2/11）、延迟（3/11）或低剂量肝素（2/11）治疗。从损伤到 ECMO 开始的中位时间为 1 天（四分位距 0.5-5.5），ECMO 持续时间的中位数为 9 天（四分位距 6.5-10.5）。6 名患者在 72 小时内开始 ECMO，出院存活率为 67%，而>72 小时开始的患者存活率为 20%。总出院存活率为 45%，VV ECMO （64%）高于其他配置（25%）。
ECMO 在大型创伤中很少使用，最常见的适应证是肺损伤引起的严重低氧性呼吸衰竭。在这群严重受伤的患者中，整体存活率较差，但 VV 组优于 VA 组，且早期（<72 小时）开始优于晚期。
