创伤救治中的体外膜肺氧合（ECMO）：你需要了解的知识。

ECMO in trauma care: What you need to know.

机构信息

From the Department of Surgery (M.F.), Brooke Army Medical Center, Fort Sam Houston, Texas; Division of Trauma and Surgical Critical Care, Department of Surgery (V.G.S.), The University of Cincinnati Medical Center, Cincinnati, Ohio; Department of Surgery (M.B.III), Columbia University Medical Center, New York, New York; Department of Anesthesiology and Critical Care Medicine (S.J.D.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Anesthesiology and Critical Care (A.A.U.), Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery (J.W.C.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics (J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), F. Edward Hébert School of Medicine at the Uniformed Services University, Bethesda, Maryland.

出版信息

J Trauma Acute Care Surg. 2024 Feb 1;96(2):186-194. doi: 10.1097/TA.0000000000004152. Epub 2023 Oct 16.

DOI:10.1097/TA.0000000000004152

PMID:37843631

Abstract

Over the past 10 years, extracorporeal membrane oxygenation (ECMO) use in trauma patients has increased significantly. This includes adult and pediatric trauma patients and even combat casualties. Most ECMO applications are in a venovenous (VV ECMO) configuration for acute hypoxemic respiratory failure or anatomic injuries that require pneumonectomy or extreme lung rest in a patient with insufficient respiratory reserve. In this narrative review, we summarize the most common indications for VV ECMO and other forms of ECMO support used in critically injured patients, underscore the importance of early ECMO consultation or regional referral, review the technical aspects of ECMO cannulation and management, and examine the expected outcomes for these patients. In addition, we evaluate the data where it exists to try to debunk some common myths surrounding ECMO management.

摘要

在过去的 10 年中，体外膜肺氧合（ECMO）在创伤患者中的应用显著增加。这包括成人和儿科创伤患者，甚至是战斗伤亡人员。大多数 ECMO 应用是在急性低氧性呼吸衰竭或解剖损伤的情况下进行的，需要行肺切除术或在呼吸储备不足的患者中进行极端的肺休息，此时采用静脉-静脉（VV ECMO）配置。在这篇叙述性综述中，我们总结了 VV ECMO 及其他形式的 ECMO 支持在重症创伤患者中的最常见适应证，强调了早期 ECMO 咨询或区域转介的重要性，回顾了 ECMO 插管和管理的技术方面，并检查了这些患者的预期结果。此外，我们还评估了现有的数据，试图驳斥一些围绕 ECMO 管理的常见误区。