Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO)

• Published in: Injury Vol. 37; no. 1; pp. 29 - 32
• Main Authors: Cordell-Smith, J.A., Roberts, N., Peek, G.J., Firmin, R.K.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 2006; Elsevier
• Subjects: Accidents, Traffic; Acute lung injury; Adolescent; Adult; ARDS; Biological and medical sciences; Diseases of the osteoarticular system; ECMO; Emergencies; Extracorporeal Membrane Oxygenation - mortality; Female; Humans; Injuries of the limb. Injuries of the spine; Injury Severity Score; Lung Injury; Male; Medical sciences; Middle Aged; Multiple Trauma - complications; Multiple Trauma - therapy; Pneumology; Pulmonary Embolism - etiology; Pulmonary Embolism - mortality; Pulmonary Embolism - therapy; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - therapy; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Survival Rate; Thoracic Injuries - complications; Thoracic Injuries - mortality; Thoracic Injuries - therapy; Trauma; Traumas. Diseases due to physical agents; Treatment Outcome; ECMO; Acute lung injury; Trauma; ARDS; Diseases of the osteoarticular system; Fracture; Respiratory failure; Cohort study; Adult; Long bone; Age; Human; Blood gas; Lung disease; Oxygen; Respiratory disease; Critically ill; Duration; Thorax; Survival; PaO2; Analysis method; Treatment; Hypoxia; Severity score; Technique; Oxygenation; Mechanical ventilation; Barotrauma
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2005.03.027

Conventional mechanical ventilation is the mainstay of treatment for severe respiratory failure associated with trauma. However, when extensive lung injury is present, this technique may not be sufficient to prevent hypoxia, and furthermore, may exacerbate pulmonary damage by barotrauma. Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill adult trauma patients and can offer an additional treatment modality. This study reports the use of ECMO in a cohort of adults referred with severe respiratory failure following trauma. Retrospective analysis over an 8-year period of all 28 adult patients referred to a single tertiary unit for ECMO support. Survival relative to Injury severity score (ISS), lung injury score (Murray grade), duration of treatment and patient age was evaluated. Twenty of 28 patients who received ECMO with severe trauma related respiratory failure (mean PaO 2/FiO 2 of 62 mmHg) survived. Most patients had long bone fractures, blunt chest trauma, or combined injuries. Lung injury and injury severity scores, patient age, ECMO duration and oxygenation indices pre-ECMO (PaO 2/FiO 2) were similar in both the survivor and non-survivor groups. A high proportion of trauma patients treated with ECMO for severe lung injury survived. This outcome appears to compare favourably to conventional ventilation techniques and may have a role in patients who develop acute severe respiratory distress associated with trauma.