PURPOSE: Extracorporeal Membrane oxygenation (ECMO) is the final rescue therapy for patients with acute respiratory distress syndrome (ARDS) refractory to conventional therapy. However, bleeding could be a problem to prohibit traumatic ARDS with brain injury to use ECMO Support. A retrospective analysis was performed to estimate the practicability of ECMO in multitrauma patients with severe brain injury and ARDS.
METHODS: Three multitrauma patients (2 males, 19 & 51 YO; 1 female, 19 YO) with severe brain injury (Subdural hematoma SDH) (Rt frontotemporal SDH with GCS E2M5V4; Rt temporo-occipital SDH with GCS E1M4V1; Bil parietal SDH with GCS E4M6V5, respectively) and ARDS, ventilated in a lung protective mode, were connected to ECMO (2 veno-venous and 1 venoarterial mode) to avoid the detrimental effects of hypoxia, hypotension and organ failure. Active clotting time (ACT) was kept around 100~200 sec. with initial one bolus, continuous low dose dripping or no heparin administration.
RESULTS: With ECMO support, hypercapnia was eliminated and the minute volume of artificial ventilation could be reduced in all patients. There was no obvious active bleeding noticed. Subsequently, ECMO was weaned from two patients, except one patient with craniotomy died 4 days after initiation of ECMO because of multiorgan failure. The survived patients were discharged without central neurologic deficit.
CONCLUSIONS: The practicability of ECMO in multitrauma patients with severe brain injury and ARDS is feasible if you can monitor ACT and platelets count meticulously even without heparin administration.
CLINICAL IMPLICATIONS: A prompt initial of ECMO support is an alternative to save multitrauma patients with severe brain injury and ARDS.
DISCLOSURE: The following authors have nothing to disclose: Tsung Tsai, Jung Yu, Yi Wu, Yeou Wang
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