Acta Cardiologica Sinica · 2016
Early Percutaneous Heparin-Free Veno-Venous Extra Corporeal Life Support (ECLS) is a Safe and Effective Means of Salvaging Hypoxemic Patients with Complicated Chest Trauma.
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Chen Thay-Hsiung, Shih James Yao-Ming, Shih Joseph Juey-Ming
Аннотация
BACKGROUND: The objective of this study was to assess the feasibility and safety of heparin-free veno-venous extracorporeal life support (VV ECLS) as a means of salvaging polytrauma patients with life-threatening hypoxemia.
METHODS: This is a retrospective observational study on 7 consecutive trauma patients who underwent VV ECLS for severe chest trauma unresponsive to conventional measures.
RESULTS: The median time to ECLS was within 10 hrs (IQR 2-53) of mechanical ventilation. Surgical interventions were performed before and during ECLS based on management priorities consistent with advanced trauma life support guidelines. No heparin was used for at least 4 days in this group with activated coagulation time (ACT) approximating 170 seconds by the 3(rd) and 4(th) day. There were no thromboembolic complications. Four patients were successfully discharged and three of these survivors had concomitant traumatic brain injury (TBI) without neurologic sequel.
CONCLUSIONS: Early VV ECLS can be used for salvage of patients with traumatic lung injury. Acute trauma care can be continued as needed under heparin-free ECLS without the fear of thromboembolic complications.
KEY WORDS: Adult respiratory distress syndrome; Extracorporeal life support; Multiple trauma; Thoracic injury; Traumatic brain injury.
METHODS: This is a retrospective observational study on 7 consecutive trauma patients who underwent VV ECLS for severe chest trauma unresponsive to conventional measures.
RESULTS: The median time to ECLS was within 10 hrs (IQR 2-53) of mechanical ventilation. Surgical interventions were performed before and during ECLS based on management priorities consistent with advanced trauma life support guidelines. No heparin was used for at least 4 days in this group with activated coagulation time (ACT) approximating 170 seconds by the 3(rd) and 4(th) day. There were no thromboembolic complications. Four patients were successfully discharged and three of these survivors had concomitant traumatic brain injury (TBI) without neurologic sequel.
CONCLUSIONS: Early VV ECLS can be used for salvage of patients with traumatic lung injury. Acute trauma care can be continued as needed under heparin-free ECLS without the fear of thromboembolic complications.
KEY WORDS: Adult respiratory distress syndrome; Extracorporeal life support; Multiple trauma; Thoracic injury; Traumatic brain injury.