Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki, Japan.
Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Graduate School of Medicine and Dental Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
BMC Emerg Med. 2024 Oct 8;24(1):179. doi: 10.1186/s12873-024-01096-6.
Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and vital organ oxygenation and is potentially useful as a bridge therapy in some trauma cases. We aimed to demonstrate the characteristics and outcomes of patients with trauma treated with veno-arterial ECMO (V-A ECMO) using data from a Japanese nationwide trauma registry.
This retrospective descriptive study analyzed data from the Japan Trauma Data Bank between January 2019 and December 2021. Patients with severe trauma (injury severity score [ISS] ≥ 9) and treated using V-A ECMO were assessed.
Among the 72,439 patients with severe trauma, 51 received V-A ECMO. Sixteen patients (31.3%) survived until hospital discharge. On hospital arrival, six (37.5%) survivors and 15 (42.9%) non-survivors experienced cardiac arrest. The median ISS for the survivor and non-survivor group was 25 (range, 25-39) and 25 (range, 17-33), respectively. Thoracic trauma was the most common type of trauma in both groups. In the non-survivor group, open-chest cardiopulmonary resuscitation, aortic cross-clamping, and resuscitative endovascular balloon occlusion of the aorta were performed in 10 (28.6%), 5 (14.3%), and 4 (11.4%) patients, respectively. However, these procedures were not performed in the survivor group. Peripheral oxygen saturation tended to be lower in the survivor group both before and upon arrival at the hospital.
The results of this study suggest the potential benefit of V-A ECMO in some challenging trauma cases. Further studies are warranted to assess the indications for V-A ECMO in patients with trauma.
体外膜肺氧合（ECMO）可提供临时循环支持和重要器官氧合，在某些创伤病例中作为桥接治疗可能是有用的。我们旨在使用日本全国创伤登记处的数据，展示接受静脉-动脉 ECMO（V-A ECMO）治疗的创伤患者的特征和结局。
这项回顾性描述性研究分析了 2019 年 1 月至 2021 年 12 月期间日本创伤数据库的数据。评估了接受 V-A ECMO 治疗的严重创伤（损伤严重程度评分[ISS]≥9）患者。
在 72439 例严重创伤患者中，有 51 例接受了 V-A ECMO 治疗。16 例患者（31.3%）存活至出院。到达医院时，6 例（37.5%）幸存者和 15 例（42.9%）非幸存者发生心脏骤停。幸存者和非幸存者组的 ISS 中位数分别为 25（范围 25-39）和 25（范围 17-33）。两组中最常见的创伤类型均为胸部创伤。在非幸存者组中，10 例（28.6%）、5 例（14.3%）和 4 例（11.4%）患者分别接受了开胸心肺复苏、主动脉夹闭和复苏性血管内球囊阻断主动脉。然而，这些程序在幸存者组中均未进行。在幸存者组中，在到达医院前后，外周血氧饱和度均较低。
本研究结果表明，V-A ECMO 在某些具有挑战性的创伤病例中可能具有潜在益处。需要进一步研究来评估创伤患者使用 V-A ECMO 的适应证。
