Extracorporeal membrane oxygenation in trauma patients: a systematic review
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(2020) 15:51
RESEARCH ARTICLE
Open Access
Extracorporeal membrane oxygenation in trauma patients: a systematic review Changtian Wang*† , Lei Zhang†, Tao Qin, Zhilong Xi, Lei Sun, Haiwei Wu and Demin Li
Abstract Background: Extracorporeal membrane oxygenation (ECMO) has evolved considerably over the past two decades and has been gradually utilized in severe trauma. However, the indications for the use of ECMO in trauma remain uncertain and the clinical outcomes are different. We performed a systematic review to provide an overall estimate of the current performance of ECMO in the treatment of trauma patients. Materials and methods: We searched PubMed and MEDLINE databases up to the end of December 2019 for studies on ECMO in trauma. The PRISMA statement was followed. Data on demographics of the patient, mechanism of injury, injury severity scores (ISS), details of ECMO strategies, and clinical outcome were extracted. Results: A total of 58 articles (19 retrospective reports and 39 case reports) were deemed eligible and included. In total, 548 patients received ECMO treatment for severe trauma (adult 517; children 31; mean age of adults 34.9 ± 12.3 years). Blunt trauma (85.4%) was the primary injury mechanism, and 128 patients had traumatic brain injury (TBI). The mean ISS was 38.1 ± 15.0. A total of 71.3% of patients were initially treated with VV ECMO, and 24.5% were placed on VA ECMO. The median time on ECMO was 9.6 days, and the median time to ECMO was 5.7 days. A total of 60% of patients received initially heparin anticoagulation. Bleeding (22.9%) and thrombosis (19%) were the most common complications. Ischemia of the lower extremities occurred in 9 patients. The overall hospital mortality was 30.3%. Conclusions: ECMO has been gradually utilized in a lifesaving capacity in severe trauma patients, and the feasibility and advantages of this technique are becoming widely accepted. The safety and effectiveness of ECMO in trauma require further study. Several problems with ECMO in trauma, including the role of VA-ECMO, the time to institute ECMO, and the anticoagulation strategy remain controversial and must be solved in future studies. Keywords: Trauma, Extracorporeal membrane oxygenation (ECMO), Systematic review
Background Polytrauma is a leading cause of death among adults [1]. The major causes of early death are hemorrhagic shock, hypoxemia, hypothermia, metabolic acidosis, coagulopathy, and severe traumatic brain injury. Among these causes, hypoxemia or acute respiratory distress syndrome (ARDS) still represents an important and frequent contributing factor toward morbidity and * Correspondence: [email protected] † Changtian Wang and Lei Zhang contributed equally to this work. Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People’s Republic of China
mortality after trauma [2, 3]. A recent systematic review demonstrated no change in the mortality of traumainduced ARDS over the last several decades, and the mortality ranges from 20.6 to 25.8% [4]. Ex
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