Early veno-venous extracorporeal membrane oxygenation is an effective strategy for traumatically injured patients presenting with refractory respiratory failure.

Autor:	Powell EK; From the Department of Emergency Medicine (E.K.P., M.K.), Program in Trauma, R Adams Cowley Shock Trauma Center (E.K.P., R.K., M.K., J.V.O., D.M.S., T.M.S.), University of Maryland School of Medicine, Baltimore, Maryland; 720 Operational Support Squadron (E.K.P., T.S.R., J.K.W.), Hurlburt Field, Florida; Department of Surgery, Emory University School of Medicine (T.S.R.), Atlanta, Georgia; Malcolm Grow Medical Clinics & Surgery Center (J.K.W.), Joint Base Andrews; United States Air Force Material Command (J.C.), Baltimore, Maryland; Air Force Special Operations Command (M.P.H.), Hurlburt Field, Florida; Division of Cardiac Surgery, Department of Surgery (B.S.T.), and Department of Anesthesiology (S.M.G.), University of Maryland School of Medicine, Baltimore, Maryland., Reynolds TS, Webb JK, Kundi R, Cantu J, Keville M, O'Connor JV, Stein DM, Hanson MP, Taylor BS, Scalea TM, Galvagno SM Jr
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2023 Aug 01; Vol. 95 (2S Suppl 1), pp. S50-S59. Date of Electronic Publication: 2023 May 29.
DOI:	10.1097/TA.0000000000004057
Abstrakt:	Background: Venovenous extracorporeal membrane oxygenation (VV ECMO) is used for respiratory failure when standard therapy fails. Optimal trauma care requires patients be stable enough to undergo procedures. Early VV ECMO (EVV) to stabilize trauma patients with respiratory failure as part of resuscitation could facilitate additional care. As VV ECMO technology is portable and prehospital cannulation possible, it could also be used in austere environments. We hypothesize that EVV facilitates injury care without worsening survival. Methods: Our single center, retrospective cohort study included all trauma patients between January 1, 2014, and August 1, 2022, who were placed on VV ECMO. Early VV was defined as cannulation ≤48 hours from arrival with subsequent operation for injuries. Data were analyzed with descriptive statistics. Parametric or nonparametric statistics were used based on the nature of the data. After testing for normality, significance was defined as a p < 0.05. Logistic regression diagnostics were performed. Results: Seventy-five patients were identified and 57 (76%) underwent EVV. There was no difference in survival between the EVV and non-EVV groups (70% vs. 61%, p = 0.47). Age, race, and gender did not differ between EVV survivors and nonsurvivors. Time to cannulation (4.5 hours vs. 8 hours, p = 0.39) and injury severity scores (34 vs. 29, p = 0.74) were similar. Early VV survivors had lower lactic acid levels precannulation (3.9 mmol/L vs. 11.9 mmol/L, p < 0.001). A multivariable logistic regression analysis examining admission and precannulation laboratory and hemodynamic values demonstrated that lower precannulation lactic acid levels predicted survival (odds ratio, 1.2; 95% confidence interval, 1.02-1.5; p = 0.03), with a significant inflection point of 7.4 mmol/L corresponding to decreased survival at hospital discharge. Conclusion: Patients undergoing EVV did not have increased mortality compared with the overall trauma VV ECMO population. Early VV resulted in ventilatory stabilization that allowed subsequent procedural treatment of injuries. Level of Evidence: Therapeutic Care/Management; Level III. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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