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01.12.2014 | Original research | Ausgabe 1/2014 Open Access

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2014

Venoarterial extracorporeal life support in post-traumatic shock and cardiac arrest: lessons learned

Zeitschrift:
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine > Ausgabe 1/2014
Autoren:
Yuan-His Tseng, Tzu-I Wu, Yuan-Chang Liu, Pyng-Jing Lin, Meng-Yu Wu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1757-7241-22-12) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare they have no competing interests.

Authors’ contributions

TYH, WTI, and LPJ contributed to the literature reviews, manuscript composition, and editing. WMY contributed to manuscript composition and editing and was responsible for the final product. LTC contributed to medical image reviews. All authors read and approved the final manuscript.

Abstract

Objectives

Venoarterial extracorporeal life support (VA-ECLS) is an effective support of acute hemodynamic collapse caused by miscellaneous diseases. However, using VA-ECLS for post-traumatic shock is controversial and may induce a disastrous hemorrhage. To investigate the feasibility of using VA-ECLS to treat post-traumatic shock or cardiac arrest (CA), a single-center experience of VA-ECLS in traumatology was reported.

Materials and methods

This retrospective study included nine patients [median age: 37 years, interquartile range (IQR): 26.5-46] with post-traumatic shock/CA who were treated with VA-ECLS in a single institution between November 2003 and October 2012. The causes of trauma were high-voltage electrocution (n = 1), penetrating chest trauma (n = 1), and blunt chest or poly-trauma (n = 7). Medians of the injury severity score and the maximal chest abbreviated injury scale were 34 (IQR: 15.5-41) and 4 (IQR: 3-4), respectively. All patients received peripheral VA-ECLS without heparin infusion for at least 24 hours.

Results

The median time from arrival at our emergency department (ED) to VA-ECLS was 6 h (IQR: 4-47.5). The median duration of VA-ECLS was 91 h (IQR: 43-187) with a duration < 24 h in 2 patients. Among the 9 patients, 5 received VA-ECLS to treat the post-traumatic shock/CA presenting during (n = 2) or following (n = 3) damage-control surgeries for initial trauma, and another 4 patients were supported for non-surgical complications associated with initial trauma. VA-ECLS was terminated in 2 non-survivors owing to uncontrolled hemothorax or retroperitoneal hemorrhage. Three patients survived to hospital discharge. All of them received damage-control surgeries for initial trauma and experienced a complicated hospitalization after weaning off VA-ECLS.

Conclusion

Using VA-ECLS to treat post-traumatic shock/CA is challenging and requires multidisciplinary expertise.
Zusatzmaterial
Authors’ original file for figure 1
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