EXTRACORPOREAL MEMBRANE OXYGENATION IN THE HYPERACUTE PHASE OF TRAUMA : A REPORT OF FOUR CASES

Abstract

　　Objective : To evaluate the indications, safety, and effectiveness of extracorporeal membrane oxygenation (ECMO) performed immediately after injury. Methods : Medical records of patients who underwent ECMO on the day of injury over a 10-year period were retrospectively reviewed. Results : Four males with a median age of 28.5 years, median injury severity score of 41, and median survival probability of 0.734 were enrolled. Three patients sustained blunt trauma and one sustained penetrating trauma. Indications included respiratory failure caused by airway hemorrhage due to bilateral lung injury in three patients and refractory ventricular fibrillation with hypothermia in one. The median duration between injury and the start of ECMO was 3 h. Two patients underwent venovenous ECMO and the other two underwent venoarterial ECMO. None of the patients received initial anticoagulation therapy. All patients exhibited improvement in acidosis immediately after ECMO. The body temperature increased quickly in one patient with hypothermia. No direct complications of ECMO were observed. Two patients survived. Conclusions : Anticoagulation therapy is not necessarily needed when ECMO is initiated. Regarding the trauma triad of death, acidosis can be improved, whereas hypothermia may be corrected. ECMO immediately after injury can be a treatment option for respiratory failure due to severe lung injury and cardiac failure.