Kakalecik Jaquelyn, Frantz Amanda M, Talerico Michael T, Krupko Thomas A, Hagen Jennifer E, Patrick Matthew R
Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA.
Department of Anesthesiology, University of Florida, Gainesville, FL, USA.
Trauma Case Rep. 2024 Apr 8;51:101020. doi: 10.1016/j.tcr.2024.101020. eCollection 2024 Jun.
Extracorporeal membrane oxygenation (ECMO) has become a salvage therapy for patients with severe acute respiratory distress syndrome (ARDS). The management of orthopaedic trauma in ECMO-supported patients with ARDS remains an evolving area of interest. Orthopaedic injuries are often temporized with external fixators, skeletal traction, or splints due to hemodynamic instability as well as concerns of exacerbating underlying pulmonary injury. However, patients requiring ECMO support do not rely on their pulmonary system for oxygenation, the need for delayed fixation may not apply. However, patients utilizing ECMO therapy can have external cardiac and pulmonary support depending on their cannulation strategy, bypassing the need for delayed fixation. We present a case series of two polytrauma patients with ARDS who underwent surgical management of pelvic ring and femoral shaft fractures while receiving ECMO support. Both patients underwent surgical management without complication and were able to be weaned from ECMO and ventilator support postoperatively. These cases highlight the potential benefits to orthopaedic fixation and underscore the need for further clinical research.
体外膜肺氧合（ECMO）已成为治疗严重急性呼吸窘迫综合征（ARDS）患者的一种挽救性治疗方法。对于接受ECMO支持的ARDS患者，骨科创伤的处理仍是一个不断发展的关注领域。由于血流动力学不稳定以及担心加重潜在的肺损伤，骨科损伤常采用外固定器、骨牵引或夹板进行临时处理。然而，需要ECMO支持的患者并不依赖其肺部系统进行氧合，因此可能不需要延迟固定。然而，根据其插管策略，接受ECMO治疗的患者可获得体外心脏和肺部支持，从而无需延迟固定。我们报告了一系列两例患有ARDS的多发伤患者的病例，他们在接受ECMO支持的同时接受了骨盆环和股骨干骨折的手术治疗。两名患者均接受了手术治疗，无并发症发生，术后能够撤离ECMO和呼吸机支持。这些病例突出了骨科固定的潜在益处，并强调了进一步临床研究的必要性。
