Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 11490, Taiwan (R.O.C)).
Department of Anesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 11490, Taiwan (R.O.C)).
Injury. 2023 Jan;54(1):124-130. doi: 10.1016/j.injury.2022.08.063. Epub 2022 Sep 7.
Both inhalation injury and acute respiratory distress syndrome (ARDS) are risk factors that predict mortality in severely burned patients. Extracorporeal life support (ECLS) is widely used to rescue these patients; however, its efficacy and safety in this critical population have not been well defined. We report our experience of using ECLS for the treatment of severely burned patients with concurrent inhalation injury and ARDS.
This was a retrospective analysis of 14 patients collected from a single medical burn center from 2012 to 2019. All patients suffered from major burns with inhalation injury and ARDS, and were treated with ECLS.
The median total body surface area of deep dermal or full thickness burns was 94.5%, ranging 47.7-99.0 %. The median revised Baux score was 122.0, ranging 90.0-155.0. All patients developed ARDS with a median partial pressure of arterial oxygen to a fraction of inspired oxygen ratio of 61.5, ranging 49.0-99.0. Indications for ECLS included sustained hypoxemia and unstable hemodynamics. The median interval for initiating ECLS was 2.5 days, ranging 1.0-156.0 days. The median duration of ECLS was 2.9 days, ranging 0.3-16.7 days. The overall survival to discharge was 42.8%. Causes of death included sepsis and multiple organ failure. ECLS-related complications included cannulation bleeding, catheter-related infection, and hemolysis. The incidence of risk factors reported in literature were higher in non-survivors, including Baux>120, albumin < 3.0 g/dL, and lactate > 8 mmol/L.
For severely burned patients with concurrent inhalation injury and ARDS, ECLS could be a salvage treatment to improve sustained hypoxemia. However, the efficacy of hemodynamic support was limited. Identifying definite ECLS indications and rigorous patient selection would contribute to better clinical outcomes.
吸入性损伤和急性呼吸窘迫综合征（ARDS）均为预测严重烧伤患者死亡率的危险因素。体外生命支持（ECLS）广泛用于抢救这些患者；然而，其在这一危重人群中的疗效和安全性尚未得到明确界定。我们报告了使用 ECLS 治疗伴有吸入性损伤和 ARDS 的严重烧伤患者的经验。
这是对 2012 年至 2019 年期间从一家医疗烧伤中心收集的 14 例患者的回顾性分析。所有患者均遭受大面积深度皮肤或全层烧伤合并吸入性损伤和 ARDS，并接受 ECLS 治疗。
患者的体表面积（TBSA）深度烧伤或全层烧伤的中位数为 94.5%，范围为 47.7-99.0%。修订的 Baux 评分中位数为 122.0，范围为 90.0-155.0。所有患者均发生 ARDS，动脉血氧分压与吸入氧分数比值中位数为 61.5，范围为 49.0-99.0。ECLS 的适应证包括持续低氧血症和不稳定的血流动力学。启动 ECLS 的中位数间隔为 2.5 天，范围为 1.0-156.0 天。ECLS 的中位数持续时间为 2.9 天，范围为 0.3-16.7 天。出院时总生存率为 42.8%。死亡原因包括脓毒症和多器官衰竭。ECLS 相关并发症包括置管出血、导管相关感染和溶血。非幸存者中报告的危险因素发生率更高，包括 Baux>120、白蛋白<3.0 g/dL 和乳酸>8 mmol/L。
对于伴有吸入性损伤和 ARDS 的严重烧伤患者，ECLS 可能是改善持续性低氧血症的挽救性治疗方法。然而，其对血流动力学支持的疗效有限。确定明确的 ECLS 适应证和严格的患者选择将有助于获得更好的临床结局。
