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Abstract
Death to trauma is caused by disastrous injuries on scene, bleeding shock or acute
respiratory failure (ARDS) induced by trauma and massive blood transfusion. Extracorporeal
membrane oxygenation (ECMO) can be effective in severe cardiopulmonary failure, but
preexisting bleeding is still a contraindication for its use. We report our first
experiences in application of initially heparin-free ECMO in severe trauma patients
with resistant cardiopulmonary failure and coexisting bleeding shock retrospectively
and describe blood coagulation management on ECMO.
From June 2006 to June 2009 we treated adult trauma patients (n=10, mean age: 32+/-14
years, mean ISS score 73+/-4) with percutaneous veno-venous (v-v) ECMO for pulmonary
failure (n=7) and with veno-arterial (v-a) ECMO in cardiopulmonary failure (n=3).
Diagnosis included polytrauma (n=9) and open chest trauma (n=1). We used a new miniaturised
ECMO device (PLS-Set, MAQUET Cardiopulmonary AG, Hechingen, Germany) and performed
initially heparin-free ECMO.
Prior to ECMO median oxygenation ratio (OR) was 47 (36-90) mmHg, median paCO(2) was
67 (36-89) mmHg and median norepinephrine demand was 3.0 (1.0-13.5) mg/h. Cardiopulmonary
failure was treated effectively with ECMO and systemic gas exchange and blood flow
improved rapidly within 2 h on ECMO in all patients (median OR 69 (52-263) mmHg, median
paCO(2) 41 (22-85) mmHg. 60% of our patients had recovered completely.
Initially heparin-free ECMO support can improve therapy and outcome even in disastrous
trauma patients with coexisting bleeding shock.