The most common causes of ARDS in burns patients are inhalation injury and bacterial pneumonia. Recently, Ainsworth et al. [51▪] have demonstrated that the survival rates among burn patients are similar to those published by ELSO (60% survival to hospital discharge) for patients with severe ARDS undergoing venous–venous ECMO. Therefore, ECMO should be considered in burn patients with ARDS.
Growing evidence suggests the potential use of ECMO for the treatment of refractory respiratory failure in adults, but the clinical benefit in polytraumatic patients is not clear.
The selection of patients and the timing for starting the treatment are crucial for success, and before starting ECMO support, risks and benefits must be considered on a case by case basis. The use of heparin should be carefully considered after a multidisciplinary discussion, involving trauma surgical team, anaesthetists and intensivists. Further studies will be warranted to evaluate the role and effect on outcome of ECMO in this cohort of patients as well as the need for organization of dedicated trauma ECMO units.
Papers of particular interest, published within the annual period of review, have been highlighted as:
1. Alberdi F, García I, Atutxa L, Zabarte M. Ephydemiology of the severe trauma
. Med Intensiva 2014; 38:580–588.
3. Butcher N, Balogh ZJ. The definition of polytrauma: the need for international consensus. Injury 2009; 40 (Suppl 4):S12–S22.
4. Pfeifer R, Pape HC. Diagnostik und Versorgungsstrategien beim polytraumatisierten Patienten. Chirurg 2016; 87:165–175.
5. Chico-Fernández M, Llompart-pou JA, Guerrero-lópez F, Sánchez-casado M. Epydemiology of the severe trauma
in Spain. Med Intesiva 2016; 40:327–347.
7. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracororporeal membrane oxygenation for severe adult respiratory failure
(CESAR): a multicentre randomised controlled trial. Lancet 2009; 374:1351–1363.
8. Kim HS, Ha SO, Han SJ, et al. Extracorporeal membrane oxygenation support in trauma
versus nontrauma patients with noninfectious acute respiratory failure
. Artif Organs 2017; 41:431–439.
9▪▪. Aaron Strumwasser A, Joshua M, Tobin J, et al. Extracorporeal membrane oxygenation in trauma
: a single institution experience and review of the literature. Int J Artif Organs 2018; 41:845–853.
This is a detailed systematic review of all the complete literature of trauma in extracorporeal membrane oxygenation (ECMO).
10▪▪. Rao P, Khalpey Z, Smith R, et al. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail 2018; 11:e004905.
This is an interesting and the latest published summary about use of venous–arterial ECMO in cardiogenic shock and cardiac arrest.
11. Grant A, Hart VJ, Lineen EB, et al. The impact of an advanced ECMO program on traumatically injured patients. Artif Organs 2018; 42:1043–1051.
12. Cordell-Smith JA, Roberts N, Peek GJ, Firmin RK. Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO). Injury 2006; 37:29–32.
13▪. Bosarge PL, Raff LA, McGwin G, et al. Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma
patients with severe adult respiratory distress syndrome. J Trauma
Acute Care Surg 2016; 81:236–243.
This is the first article showing results on outcome of ECMO in trauma, with first indications about timing of extracorporeal initiation in trauma setting.
14. Huh U, Song S, Chung SW, et al. Is extracorporeal cardiopulmonary resuscitation practical in severe chest trauma
? A systematic review in single center of developing country. J Trauma
Acute Care Surg 2017; 83:903–907.
15▪. Ull C, Schildhauer TA, Strauch JT, Swol J. Outcome measures of extracorporeal life support (ECLS) in trauma
patients versus patients without trauma
: a 7-year single-center retrospective cohort study. J Artif Organs 2017; 20:117–124.
The study, although being single centre, shows the outcome results of ECMO in trauma and not trauma patients.
16. Arlt M, Philipp A, Voelkel S, et al. Extracorporeal membrane oxygenation in severe trauma
patients with bleeding shock. Resuscitation 2010; 81:804–809.
17. Diehl JL, Mercat A, Pesenti A. Understanding hypoxemia on ECCO2R: back to the alveolar gas equation. Intensive Care Med 2018; doi: 10.1007/s00134-018-5409-0. [Epub ahead of print].
18. Boyle AJ, Sklar MC, McNamee J, et al. Extracorporeal carbon dioxide removal for lowering the risk of mechanical ventilation: research questions and clinical potential for the future. Lancet Respir Med 2018; 6:874–884.
19. Zapol WM, Snider MT, Hill JD, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure
. A randomized prospective study. JAMA 1979; 242:2193–2196.
20. Morris AH, Wallace CJ, Menlove RL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2
removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 1994; 149:295–305.
21▪▪. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory syndrome (EOLIA trial). N Engl J Med 2018; 378:1956–1975.
This is the latest multicenter RCT trial of venous–venous ECMO, whose results have been published in 2018 and discussed all over the world.
22. Zonies D, Merkel M. Advanced extracorporeal therapy in trauma
. Curr Opin Crit Care 2016; 22:578–583.
23▪. Robba C, Ortu A, Bilotta F, et al. Extracoroporeal membrane oxygenation for adult respiratory distress syndrome in trauma
patients: a case series and systematic literature review. J Trauma
Acute Care Surg 2017; 82:165–173.
This is a case series, which includes patients with traumatic brain injury (TBI), describing use of ECMO in trauma patients and a systematic review of the literature. This study shows that no trauma patients died because of complication directly related to ECMO.
24. Oliver WC. Anticoagulation
and coagulation management for ECMO. Semin Cardiothorac Vasc Anesth 2009; 13:154–175.
25. Sy E, Sklar MC, Lequier L, et al. Anticoagulation
practices and the prevalence of major bleeding, thromboembolic events, and mortality in venoarterial extracorporeal membrane oxygenation: a systematic review and meta-analysis. J Crit Care 2017; 39:87–96.
26. Lazzara RR, Magovern JA, Benchart DH, et al. Extracorporeal membrane oxygenation for adults post cardiotomy cardiogenic shock using a heparin
bonded system. ASAIO J 1993; 39:M444–M447.
27. Ryu KM, Chang SW. Heparin
-free extracorporeal membrane oxygenation in a patient with severe pulmonary contusions and bronchial disruption. Clin Exp Emerg Med 2018; 5:204–207.
28▪. Chen M, Evans A, Gutsche J. Success with VV ECMO for respiratory failure
: is it the device, the center or both? J Cardiothorac Vasc Anesth 2018; 16:232–238.
The article shows correlation between success of extra corporeal support and the centre where this is managed and the type of ECMO device.
29. Keebler ME, Haddad EV, Choi CW, et al. Venoarterial extracorporeal membrane oxygenation in cardiogenic shock. JACC Heart Fail 2018; 6:503–516.
30. Cavarocchi NC. Introduction to extracorporeal membrane oxygenation. Crit Care Clin 2017; 33:763–766.
31. Tseng YH, Wu TI, Liu YC, et al. Venoarterial extracorporeal life support in post traumatic shock and cardiac arrest: lessons learned. Scand J Trauma
Resusc Emerg Med 2014; 22:12.
32. Lee SK, Gongora EO, Donnel S, et al. Intraoperative rescue extracorporeal membrane oxygenation and damage control during repair of a traumatic aortic injury. J Surg Case Rep 2017; 2:rjx022.
33. Peigh G, Carovacchi N, Hirose H. Saving life and brain with extracorporeal cardiopulmonary resuscitation: a single-center analysis of in-hospital cardiac arrests. J Thorac Cardiovas Surg 2015; 150:1344–1349.
34. Lin CY, Tsai FC, Lee HA, et al. Extracorporeal membrane oxygenation support in posttraumatic cardiopulmonary failure: a 10-year single institutional experience. Medicine 2017; 96:e6067.
35. Zangrillo A, Landoni G, Biondi-Zoccai G, et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc 2013; 15:172–178.
36. Bonacchi M, Spina R, Torracchi L. Extracorporeal life support in patients with severe trauma
: an advanced treatment strategy for refractory clinical settings. J Thorac Cardiovasc Surg 2013; 145:1617–1626.
37. Mahmood S, Bilal H, Zaman M, Tang A. Is a fully heparin
-bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit? Interact Cardiovasc Thorac Surg 2012; 14:406–414.
38. Muellenbach RM, Kredel M, Kunze E, et al. Prolonged heparin
-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome
patients with traumatic brain injury. J Trauma
Acute Care Surg 2012; 72:1444–1447.
39. Chen CY, Hsu TY, Chen WK, et al. The use of extracorporeal membrane oxygenation in trauma
patients: a national case–control study. Medicine (Baltimore) 2018; 97:e12223.
40▪. Swol J, Brodie D, Napolitano L, et al. Indications and outcomes of extracorporeal life support in trauma
patients. J Trauma
Acute Care Surg 2018; 84:831–837.
The article underlines in a detailed manner indications and outcomes of ECMO in trauma setting.
41▪. Zonies D, Merkel M. Advanced extracorporeal therapy in trauma
. Curr Opin Crit Care 2016; 22:578–583.
This is a current opinion article, such as a detailed and up to date state of the art regarding ECMO in trauma.
42. Ried M, Bein T, Philipp A, et al. Extracorporeal lung support in trauma
patients with severe chest injury and acute lung failure: a 10-year institutional experience. Crit Care 2013; 17:R110.
43. Haile DT, Schears GJ. Optimal time for initiating extracorporeal membrane oxygenation. Semin Cardiothorac Vasc Anesth 2009; 13:146–153.
44. Borsage PL, Raff LA, McGowin G, et al. Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma
patients with severe adult respiratory distress syndrome. J Trauma
Acute Care Surg 2016; 81:236–324.
45. Ahmad SB, Menaker J, Kufera JO, et al. Extracorporeal membrane oxygenation after traumatic injury. J Trauma
Acute Care Surg 2017; 82:587–591.
46. Biscotti M, Gannon WD, Abrams D, et al. Extracorporeal membrane oxygenation use in patients with traumatic brain injury. Perfusion 2015; 30:407–409.
47▪. Della Torre V, Badenes R, Corradi F, et al. Acute respiratory distress syndrome
in traumatic brain injury: how do we manage it? J Thorac Dis 2017; 9:5368–5381.
The systematic review explains the challenges in ventilating patients with concomitance of acute respiratory distress syndrome and TBI.
48. Yen TS, Liau CC, Chen YS, et al. Extracorporeal membrane oxygenation resuscitation for traumatic brain injury after decompressive craniotomy. Clin Neurol Neurosurg 2008; 110:295–297.
49. Biderman P, Einav S, Fainblut M, et al. Extracorporeal life support in patients with multiple injuries and severe respiratory failure
: a single centre experience? J Trauma
Acute Care Surg 2013; 75:907–912.
50. Jacobs JV, Hooft NM, Robinson BR, et al. The use of extracorporeal membrane oxygenation in blunt thoracic trauma
: a study of the extracorporeal life support organization database. J Trauma
Acute Care Surg 2015; 79:1049–1053.
51▪. Ainsworth CR, Dellavolpe J, Chung KK, et al. Revisiting extracorporeal membrane oxygenation for ARDS in burns: a case series and review of the literature. Burns 2018; 44:1433–1438.
This is one of the very few articles about ECMO in burn patients, showing correlated good outcomes.
* Della Torre and Chiara Robba contributed equally to the article.