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01-08-2018 | Original Scientific Report

Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) for Acute Respiratory Failure Following Injury: Outcomes in a High-Volume Adult Trauma Center with a Dedicated Unit for VV ECMO

Authors: Jay Menaker, Ronald B. Tesoriero, Ali Tabatabai, Ronald P. Rabinowitz, Christopher Cornachione, Terence Lonergan, Katelyn Dolly, Raymond Rector, James V. O’Connor, Deborah M. Stein, Thomas M. Scalea

Published in: World Journal of Surgery | Issue 8/2018

Abstract

Introduction

The use of veno-venous extracorporeal membrane oxygenation (VV ECMO) has increased over the past decade. The purpose of this study was to evaluate outcomes in adult trauma patients requiring VV ECMO.

Methods

Data were collected on adult trauma patients admitted between January 1, 2015, and November 1, 2016. Demographics, injury-specific data, ECMO data, and survival to discharge were recorded. Medians [interquartile range (IQR)] were reported. A p value ≤0.05 was considered statistically significant.

Results

Eighteen patients required VV ECMO during the study period. Median age was 28.5 years (IQR 24–43). Median injury severity score (ISS) was 27 (IQR 21–41); median PaO₂/FiO₂ (P/F) prior to ECMO cannulation was 61 (IQR 50–70). Median time from injury to cannulation was 3 (IQR 0–6) days. Median duration of ECMO was 266 (IQR 177–379) hours. Survival to discharge was 78%. Survivors had a significantly higher ISS (p = 0.03), longer intensive care unit length of stay (ICU LOS) (p < 0.0004), hospital LOS (p < 0.000004), and time on the ventilator (p < 0.0003). Median time of injury to cannulation was significantly longer in patients who survived to discharge (p = 0.01). There was no difference in P/F ratio prior to cannulation (p = ns).

Conclusion

We have demonstrated improved outcome of patients requiring VV ECMO following injury compared to historical data. Although shorter time from injury to cannulation for VV ECMO was associated with death, select patients who meet criteria for VV ECMO early following injury should be referred/transferred to a tertiary care facility that specializes in trauma and ECMO care.

Center for Disease Control. Injury Prevention and Control. Ten leading causes of death and Injury 2015. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif. Accessed 18 Oct 2017

Tisherman SA, Schmicker RH, Brasel KJ, Bulger EM, Kerby JD, Minei JP et al (2015) Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the Resuscitation Outcomes Consortium. Ann Surg 261(3):586–590CrossRefPubMedPubMedCentral

Navarrete-Navarro P, Rodriguez A, Reynolds N, West R, Rivera R, Scalea T (2001) Adult respiratory distress syndrome among blunt and penetrating trauma patients: demographics, mortality, and resource utilization over 8 years. J Crit Care 16:47–53CrossRefPubMed

Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A, ARDS Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308CrossRefPubMed

Papazain L, Forel JM, Gacoui A, Penot-Ragon C, Perrin G, Loundou A et al (2010) Neuromuscular blocker in early acute respiratory distress syndrome. N Engl J Med 363:1107–1116CrossRef

Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T et al (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168CrossRefPubMed

Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH et al (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA 242:2193–2196CrossRefPubMed

Morris AH, Wallace CJ, Menlove RL, Clemmer TP, Orme JF Jr, Weaver LK et al (1994) Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO₂ removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 149(2 Pt 1):295–305CrossRefPubMed

Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363CrossRefPubMed

10.

Cianchi G, Bonizzoli M, Pasquini A, Bonacchi M, Zagli G, Ciapetti M et al (2011) Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center. BMC Pulm Med 11:1–9CrossRef

11.

Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators et al (2009) Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA 302:1888–1895CrossRefPubMed

12.

Beurtheret S, Mastroianni C, Pozzi M, D’Alessandro C, Luyt CE, Combes A et al (2001) Extracorporeal membrane oxygenation for 2009 infeluenzxa A (H1N1) acute respiratory distress syndrome: single-centre experience with 1-year follow up. Eur J Cardiothorac Surg 41:691–695CrossRef

13.

Extracorporeal Life Support Organization. ECLS Registry report. United States Summary. July 2017

14.

Muellenbach RM, Kredel M, Kunze E, Kranke P, Kuestermann J, Brack A et al (2012) Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury. J Trauma Acute Care Surg 72:1444–1447CrossRefPubMed

15.

Zonies D, Merkel M (2016) Advanced extracorporeal therapy in trauma. Curr Opin Crit Care 22(6):578–583CrossRefPubMed

16.

Ahmad SB, Menaker J, Kufera J, OʼConnor J, Scalea TM, Stein DM (2017) Extracorporeal membrane oxygenation after traumatic injury. J Trauma Acute Care Surg 82:587–591CrossRefPubMed

17.

Menaker J, Dolly K, Rector R, Kufera J, Lee EE, Tabatabai A et al (2017) The Lung Rescue Unit (LRU)—does a dedicated intensive care unit for veno-venous extra-corporeal membrane oxygenation (VV ECMO) improve survival to discharge? J Trauma Acute Care Surg 83:438–442CrossRefPubMed

18.

Michaels AJ, Schriener RJ, Kolla S, Awad SS, Rich PB, Reickert C et al (1999) Extracorporeal life support in pulmonary failure after trauma. J Trauma 46:638–645CrossRefPubMed

19.

Biderman P, Einav S, Fainblut M, Stein M, Singer P, Medalion B (2013) Extracorporeal life support in patients with multiple injuries and severe respiratory failure: a single-center experience? J Trauma Acute Care Surg 75:907–912CrossRefPubMed

20.

Guirand DM, Okoye OT, Schmidt BS, Mansfield NJ, Aden JK, Martin RS et al (2014) Venovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure: a multicenter retrospective cohort study. J Trauma Acute Care Surg 76:1275–1281CrossRefPubMed

21.

Ried M, Bein T, Philipp A, Müller T, Graf B, Schmid C et al (2013) Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. Crit Care 17:R110CrossRefPubMedPubMedCentral

22.

Jacobs JV, Hooft NM, Robinson BR, Todd E, Bremner RM, Petersen SR, Smith MA (2015) The use of extracorporeal membrane oxygenation in blunt thoracic trauma: a study of the Extracorporeal Life Support Organization database. J Trauma Acute Care Surg 79:1049–1053CrossRefPubMed

23.

Bosarge PL, Raff LA, McGwin G Jr, Carroll SL, Bellot SC, Diaz-Guzman E, Kerby JD (2016) Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma patients with severe adult respiratory distress syndrome. J Trauma Acute Care Surg 81:236–243CrossRefPubMed

24.

Cordell-Smith JA, Roberts N, Peek GJ, Firmin RK (2006) Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO). Injury 37:29–32CrossRefPubMed

25.

Riccabona M, Kuttnig-Haim M, Dacar D, Urlesberger B, Reiterer F, Maurer U, Zobel G (1997) Venous thrombosis in and after extracorporeal membrane oxygenation: detection and follow-up by color Doppler sonography. Eur Radiol 7:1383–1386CrossRefPubMed

26.

Shafii AE, Brown CR, Murthy SC, Mason DP (2012) High incidence of upper-extremity deep vein thrombosis with dual lumen venovenous extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 144:988–989CrossRefPubMed

27.

Brenner K, Cunningham J, Bacchetta M, Brodie D (2012) Catheter associated deep vein thrombosis and level of anticoagulation in adult patients requiring extra-corporeal membrane oxygenation for respiratory failure. Am J Respir Crit Care Med 185:A6014

28.

Cooper E, Burns J, Retter A, Salt G, Camporota L, Meadows CI et al (2015) Prevalence of venous thrombosis following venovenous extracorporeal membrane oxygenation in patients with severe respiratory failure. Crit Care Med 43:e581–e584CrossRefPubMed

29.

Menaker J, Tabatabai A, Rector R, Dolly K, Kufera J, Lee E et al (2017) Incidence of cannula associated deep vein thrombosis after veno-venous ECMO. ASAIO J 63:588–591CrossRefPubMed

30.

Marinella MA, Kathula SK, Markert RJ (2000) Spectrum of upper extremity deep vein thrombosis in a community teaching hospital. Heart Lung 29:113–117CrossRefPubMed

31.

Savage KJ, Wells PS, Schulz V, Goudie D, Morrow B, Cruickshank M, Kovacs MJ (1999) Outpatient use of low molecular weight heparin (Dalteparin) for the treatment of deep vein thrombosis of the upper extremity. Thromb Haemost 82:1008–1010CrossRefPubMed

32.

Monreal M, Lafoz E, Ruiz J, Valls R, Alastrue A (1991) Upper-extremity deep vein thrombosis and pulmonary embolism: a prospective study. Chest 99:280–283CrossRefPubMed

33.

Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ (2012) American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:7s–47sCrossRefPubMedPubMedCentral

34.

Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352CrossRefPubMed

Title: Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) for Acute Respiratory Failure Following Injury: Outcomes in a High-Volume Adult Trauma Center with a Dedicated Unit for VV ECMO
Authors: Jay Menaker
Ronald B. Tesoriero
Ali Tabatabai
Ronald P. Rabinowitz
Christopher Cornachione
Terence Lonergan
Katelyn Dolly
Raymond Rector
James V. O’Connor
Deborah M. Stein
Thomas M. Scalea
Publication date: 01-08-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 8/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4480-6

At a glance: The STEP trials

Springer Medicine

Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) for Acute Respiratory Failure Following Injury: Outcomes in a High-Volume Adult Trauma Center with a Dedicated Unit for VV ECMO

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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