Lee Alex, Romano Kali, Tansley Gavin, Al-Khaboori Sadiq, Thiara Sonny, Garraway Naisan, Finlayson Gordon, Kanji Hussein D, Isac George, Ta Kim Long, Sidhu Amandeep, Carolan Mark, Triana Eleanor, Summers Cara, Joos Emilie, Ball Chad G, Hameed Syed Morad
From the Division of General Surgery, Department of Surgery (A.L., G.T., S.A.-K., N.G., E.J., S.M.H.), Division of Critical Care, Department of Medicine (A.L., S.T., N.G., G.F., H.D.K., G.I., M.H.), Department of Anesthesiology and Perioperative Care (A.L., G.F., G.I., M.C.), University of British Columbia; Perfusion Services (K.T., A.S., E.T., C.S.), Vancouver General Hospital, Vancouver, BC; and Division of General Surgery, Department of Surgery (C.G.B.), University of Calgary, Calgary, AB, Canada.
J Trauma Acute Care Surg. 2024 Jan 1;96(1):145-155. doi: 10.1097/TA.0000000000004043. Epub 2023 Jun 29.
Clarity about indications and techniques in extracorporeal life support (ECLS) in trauma is essential for timely and effective deployment, and to ensure good stewardship of an important resource. Extracorporeal life support deployments in a tertiary trauma center were reviewed to understand the indications, strategies, and tactics of ECLS in trauma.
The provincial trauma registry was used to identify patients who received ECLS at a Level I trauma center and ECLS organization-accredited site between January 2014 and February 2021. Charts were reviewed for indications, technical factors, and outcomes following ECLS deployment. Based on this data, consensus around indications and techniques for ECLS in trauma was reached and refined by a multidisciplinary team discussion.
A total of 25 patients underwent ECLS as part of a comprehensive trauma resuscitation strategy. Eighteen patients underwent venovenous ECLS and seven received venoarterial ECLS. Nineteen patients survived the ECLS run, of which 15 survived to discharge. Four patients developed vascular injuries secondary to cannula insertion while four patients developed circuit clots. On multidisciplinary consensus, three broad indications for ECLS and their respective techniques were described: gas exchange for lung injury, extended damage control for severe injuries associated with the lethal triad, and circulatory support for cardiogenic shock or hypothermia.
The three broad indications for ECLS in trauma (gas exchange, extended damage control and circulatory support) require specific advanced planning and standardization of corresponding techniques (cannulation, circuit configuration, anticoagulation, and duration). When appropriately and effectively integrated into the trauma response, ECLS can extend the damage control paradigm to enable the management of complex multisystem injuries.
Therapeutic/Care Management; Level IV.
明确创伤体外生命支持（ECLS）的适应症和技术对于及时有效地应用该技术至关重要，同时也有助于确保对这一重要资源的合理管理。回顾了一家三级创伤中心的体外生命支持应用情况，以了解创伤中ECLS的适应症、策略和方法。
利用省级创伤登记系统，确定2014年1月至2021年2月期间在一级创伤中心和经ECLS组织认证的机构接受ECLS治疗的患者。查阅病历，了解ECLS应用后的适应症、技术因素和治疗结果。基于这些数据，多学科团队讨论达成并完善了创伤中ECLS适应症和技术的共识。
共有25例患者接受了ECLS治疗，作为综合创伤复苏策略的一部分。18例患者接受了静脉-静脉ECLS，7例接受了静脉-动脉ECLS。19例患者在ECLS治疗过程中存活，其中15例存活至出院。4例患者因插管导致血管损伤，4例患者出现回路凝血。根据多学科共识，描述了ECLS的三种主要适应症及其各自的技术：肺损伤的气体交换、与致死三联征相关的严重损伤的扩大损伤控制、心源性休克或低温的循环支持。
创伤中ECLS的三种主要适应症（气体交换、扩大损伤控制和循环支持）需要特定的预先规划和相应技术（插管、回路配置、抗凝和持续时间）的标准化。当ECLS适当地、有效地整合到创伤救治中时，它可以扩展损伤控制模式，以实现对复杂多系统损伤的管理。
治疗/护理管理；四级。
