Academic Journal
VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION IMPROVES OUTCOMES IN TRAUMA PATIENTS SUFFERING RESPIRATORY FAILURE.
| Τίτλος: | VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION IMPROVES OUTCOMES IN TRAUMA PATIENTS SUFFERING RESPIRATORY FAILURE. |
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| Συγγραφείς: | Powell EK, Betzold R; University of Arkansas for Medical Sciences, Little Rock, Arkansas., Lammers DT; United States Army., Podell J, Wan R; United States Air Force., Teeter W, Hardin RD; United States Army., Scalea TM, Galvagno SM |
| Πηγή: | Shock (Augusta, Ga.) [Shock] 2025 Feb 01; Vol. 63 (2), pp. 248-254. Date of Electronic Publication: 2024 Oct 24. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 9421564 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1540-0514 (Electronic) Linking ISSN: 10732322 NLM ISO Abbreviation: Shock Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2002- : Philadelphia : Lippincott Williams & Wilkins Original Publication: Augusta, GA : BioMedical Press, [1994- |
| Ιατρικοί όροι (MeSH): | Extracorporeal Membrane Oxygenation*/methods , Respiratory Insufficiency*/therapy , Respiratory Insufficiency*/mortality , Respiratory Insufficiency*/etiology , Wounds and Injuries*/therapy , Wounds and Injuries*/complications , Wounds and Injuries*/mortality, Humans ; Female ; Male ; Middle Aged ; Adult ; Retrospective Studies ; Treatment Outcome ; Propensity Score ; Cohort Studies |
| Περίληψη: | Abstract: Introduction: Veno-venous extracorporeal membrane oxygenation (VV ECMO) improves hypoxemia and carbon dioxide clearance in patients with severe respiratory derangements. A greater understanding of the potential benefits of VV ECMO in trauma patients could lead to broader adoption. We hypothesize that trauma patients who receive VV ECMO have improved mortality outcomes when compared to those receiving conventional ventilator management given the rapid stabilization VV ECMO promotes. Methods: We performed a single-center, propensity score-matched cohort study. All trauma patients from January 1, 2014, to October 30, 2023, who were placed on VV ECMO or who would have met institutional guidelines for VV ECMO but were managed with conventional ventilator strategies were matched 1:1. The primary outcome analysis was survival at hospital discharge. Significance was defined as P < 0.05. Results: Eighty-one trauma VV ECMO patients and 128 patients who received conventional management met criteria for inclusion. After matching, VV ECMO and conventional treatment cohort characteristics were similar in age and mechanism of injury. Matched ISS, SI, lactate levels, and frequency of traumatically brain injured were also similar. Finally, respiratory parameters including preintervention, pH, partial pressure of carbon dioxide, lactate levels, and oxygen saturation were similar between matched groups. VV ECMO patients had higher survival rates at discharge when compared to the matched conventional treatment group (70% vs. 41%, P < 0.001). Corresponding hazard ratio for VV ECMO use was 0.31 (95% CI 0.18-0.52; P < 0.001). The odds ratio of mortality in matched trauma patients who receive VV ECMO versus conventional treatment was 0.29 (95% CI 0.14-0.58; P < 0.001). Conclusion: VV ECMO may represent a safe, alternative treatment approach for appropriately screened trauma patients with acute respiratory failure; however, further studies are warranted. (Copyright © 2024 by the Shock Society.) |
| Competing Interests: | The authors report no conflicts of interest. |
| References: | Blandino Ortiz A, Cabestrero Alonso D, De Pablo Sanchez R. Veno-venous ECMO indications: more than respiratory support. Crit Care . 2019;23(1):275. Amos T, Bannon-Murphy H, Yeung M, et al. ECMO (extra corporeal membrane oxygenation) in major trauma: a 10 year single centre experience. Injury . 2021;52(9):2515–2521. Kim SH, Huh U, Song S, et al. Outcomes in trauma patients undergoing veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome. Perfusion . 2022;38:1037–1044. Powell MEK, Reynolds TS, Webb JK, et al. Early veno-venous extracorporeal membrane oxygenation is an effective strategy for traumatically injured patients presenting with refractory respiratory failure. J Trauma Acute Care Surg . 2023;95:S50–S59. doi:10.1097/TA.0000000000004057. (PMID: 10.1097/TA.0000000000004057) Guirand DM, Okoye OT, Schmidt BS, et al. 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 . 2014;76(5):1275–1281. Al-Thani H, Al-Hassani A, El-Menyar A, et al. Outcome of post-traumatic acute respiratory distress syndrome in young patients requiring extracorporeal membrane oxygenation (ECMO). Sci Rep . 2022;12(1):10609. Harnisch L-O, Moerer O. Contraindications to the initiation of veno-venous ECMO for severe acute respiratory failure in adults: a systematic review and practical approach based on the current literature. Membranes (Basel) . 2021;11(8):584. Austin SE, Galvagno SM, Podell JE, et al. Veno-venous extracorporeal membrane oxygenation in patients with traumatic brain injuries and severe respiratory failure: a single-center retrospective analysis. J Trauma Acute Care Surg . 2023. doi:10.1097/TA.0000000000004159. (PMID: 10.1097/TA.0000000000004159) Ahmad SB, Menaker J, Kufera J, et al. Extracorporeal membrane oxygenation after traumatic injury. J Trauma Acute Care Surg . 2017;82(3):587–591. Carter KT, Kutcher ME, Shake JG, et al. Heparin-sparing anticoagulation strategies are viable options for patients on veno-venous ECMO. J Surg Res . 2019;243:399–409. Harris PA, Taylor R, Thielke R, et al. Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform . 2009;42(2):377–381. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform . 2019;95:103208. Camporota L, Rose L, Andrews PL, et al. Airway pressure release ventilation for lung protection in acute respiratory distress syndrome: an alternative way to recruit the lungs. Curr Opin Crit Care . 2024;30(1):76–84. Pirracchio R, Resche-Rigon M, Chevret S. Evaluation of the propensity score methods for estimating marginal odds ratios in case of small sample size. BMC Med Res Methodol . 2012;12:70. Cenzer I, Boscardin WJ, Berger K. Performance of matching methods in studies of rare diseases: a simulation study. Intractable Rare Dis Res . 2020;9(2):79–88. Ahmed N, Kuo YH, Pratt A. Outcomes of extracorporeal membrane oxygenation in acute respiratory distress syndrome following traumatic injury: a propensity-matched analysis. Crit Care Explor . 2021;3(5):e0421. Swol J, Cannon JW, Barbaro RP, et al. Extracorporeal membrane oxygenation in trauma. ASAIO J . 2022;68(4):e62–e63. Lee NH, Kim SH, Seo SH, et al. Prediction of respiratory complications by quantifying lung contusion volume using chest computed tomography in patients with chest trauma. Sci Rep . 2023;13(1):6387. Benson AB, Moss M, Silliman CC. Transfusion-related acute lung injury (TRALI): a clinical review with emphasis on the critically ill. Br J Haematol . 2009;147(4):431–443. Edgecombe L, Sigmon DF, Galuska MA, et al.: Thoracic Trauma. In: StatPearls . 2024. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30521264 . Accessed October 30, 2024. Spaite DW, Hu C, Bobrow BJ, et al. The effect of combined out-of-hospital hypotension and hypoxia on mortality in major traumatic brain injury. Ann Emerg Med . 2017;69(1):62–72. Corwin GS, Sexton KW, Beck WC, et al. Characterization of acidosis in trauma patient. J Emerg Trauma Shock . 2020;13(3):213–218. Lammers D, Rokayak O, Uhlich R, et al. Early use of extracorporeal membrane oxygenation for traumatically injured patients: a national trauma database analysis. Am Surg . 2023;89(8):3399–3405. Goto T, Yaguchi S, Ogasawara J, et al. Early initiation of venovenous extracorporeal membrane oxygenation for critically ill COVID-19 patients. J Extra Corpor Technol . 2022;54(1):79–82. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med . 2018;378(21):1965–1975. Supady A, Combes A, Barbaro RP, et al. Respiratory indications for ECMO: focus on COVID-19. Intensive Care Med . 2022;48(10):1326–1337. van Veelen MJ, Brodmann Maeder M. Hypothermia in trauma. Int J Environ Res Public Health . 2021;18(16):8719. Mendes PV, Park M, de Azevedo LCP, et al. Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure. Intensive Care Med Exp . 2022;10(1):15. Biscotti M, Gannon WD, Abrams D, et al. Extracorporeal membrane oxygenation use in patients with traumatic brain injury. Perfusion . 2015;30(5):407–409. Parker BM, Menaker J, Berry CD, et al. Single center experience with veno-venous extracorporeal membrane oxygenation in patients with traumatic brain injury. Am Surg . 2021;87(6):949–953. Niemeyer M, Jochems D, Houwert RM, et al. Mortality in polytrauma patients with moderate to severe TBI on par with isolated TBI patients: TBI as last frontier in polytrauma patients. Injury . 2022;53(4):1443–1448. Yan EB, Satgunaseelan L, Paul E, et al. Post-traumatic hypoxia is associated with prolonged cerebral cytokine production, higher serum biomarker levels, and poor outcome in patients with severe traumatic brain injury. J Neurotrauma . 2014;31(7):618–629. Tiruvoipati R, Pilcher D, Botha J, et al. Association of hypercapnia and hypercapnic acidosis with clinical outcomes in mechanically ventilated patients with cerebral injury. JAMA Neurol . 2018;75(7):818–826. |
| Entry Date(s): | Date Created: 20241026 Date Completed: 20250425 Latest Revision: 20250516 |
| Update Code: | 20260130 |
| DOI: | 10.1097/SHK.0000000000002491 |
| PMID: | 39456115 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1540-0514 |
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| DOI: | 10.1097/SHK.0000000000002491 |