Bingoel Alperen S, Schlottmann Frederik, Plinke Clarissa, Dastagir Khaled, Obed Doha, Enechukwu Anieto, Dieck Thorben, Wellkamp Lukas, Hanke Jasmin Sarah, Kühn Christian, Ruhparwar Arjang, Krezdorn Nicco, Vogt Peter M
Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany.
Division of Plastic Surgery, Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany.
Innov Surg Sci. 2024 Sep 16;10(2):73-80. doi: 10.1515/iss-2024-0024. eCollection 2025 Jun.
The treatment of acute respiratory distress syndrome (ARDS) in burn patients remains a major challenge. Veno-venous extracorporeal membrane oxygenation (vv-ECMO) is a standard treatment for severe ARDS today. But reports on survival outcome in burn patients remain variable in the literature. The aim of this study is to identify factors that may influence survival and therapy outcomes in this distinct patient population.
A single-center retrospective study was conducted in the burn intensive care unit (BICU). Inclusion criteria were the use of vv-ECMO for ARDS after burn injuries. The data analyzed included general medical data and various parameters from the BICU.
Between January 2012 and December 2022, 21 consecutive adult patients were identified who underwent vv-ECMO treatment. Five patients (24 %) survived the therapy and could be discharged, and 16 patients (76 %) succumbed to their disease. A higher TBSA affected, lower pH in arterial blood gas analysis after 24 and 36 h, multiorgan dysfunction syndrome (MODS), renal insufficiency, and renal replacement therapy were significantly associated with a lethal outcome.
The data from the present study showed an overall mortality rate of 76 %, which is unsatisfactory compared to the literature. This could be explained by complicating factors such as MODS, renal failure, and renal replacement therapy. However, the indication for vv-ECMO must be adapted to the individual situation of the respective patient. Due to the additional higher risk for complications, the utilization of ECMO therapy should be reserved for specialized burn centers with an interdisciplinary setting.
烧伤患者急性呼吸窘迫综合征（ARDS）的治疗仍然是一项重大挑战。静脉-静脉体外膜肺氧合（vv-ECMO）是当今治疗严重ARDS的标准疗法。但关于烧伤患者生存结局的报道在文献中仍存在差异。本研究的目的是确定可能影响这一特殊患者群体生存及治疗结局的因素。
在烧伤重症监护病房（BICU）进行了一项单中心回顾性研究。纳入标准为烧伤后因ARDS使用vv-ECMO。分析的数据包括一般医学数据和来自BICU的各种参数。
2012年1月至2022年12月期间，共确定21例接受vv-ECMO治疗的成年患者。5例患者（24%）治疗后存活并出院，16例患者（76%）死于疾病。烧伤总面积更大、24小时和36小时后动脉血气分析中pH值更低、多器官功能障碍综合征（MODS）、肾功能不全及肾脏替代治疗与致死结局显著相关。
本研究数据显示总体死亡率为76%，与文献相比并不理想。这可能由MODS、肾衰竭和肾脏替代治疗等复杂因素解释。然而，vv-ECMO的适应证必须根据各患者的具体情况进行调整。由于并发症风险更高，ECMO治疗应仅用于具备跨学科环境的专业烧伤中心。
