Venoarterial extracorporeal life support in post-traumatic shock and cardiac arrest: lessons
learned
Sammanfattning
OBJECTIVES:
Venoarterial extracorporeal life support (VA-ECLS) is an effective support of acute hemodynamic
collapse caused by miscellaneous diseases. However, using VA-ECLS for post-traumatic shock is
controversial and may induce a disastrous hemorrhage. To investigate the feasibility of using VA-
ECLS to treat post-traumatic shock or cardiac arrest (CA), a single-center experience of VA-ECLS in
traumatology was reported.
MATERIALS AND METHODS:
This retrospective study included nine patients [median age: 37 years, interquartile range (IQR): 26.5
-46] with post-traumatic shock/CA who were treated with VA-ECLS in a single institution between
November 2003 and October 2012. The causes of trauma were high-voltage electrocution (n = 1),
penetrating chest trauma (n = 1), and blunt chest or poly-trauma (n = 7). Medians of the injury severity
score and the maximal chest abbreviated injury scale were 34 (IQR: 15.5-41) and 4 (IQR: 3-4),
respectively. All patients received peripheral VA-ECLS without heparin infusion for at least 24 hours.
RESULTS:
The median time from arrival at our emergency department (ED) to VA-ECLS was 6 h (IQR: 4-47.5). The
median duration of VA-ECLS was 91 h (IQR: 43-187) with a duration < 24 h in 2 patients. Among the 9
patients, 5 received VA-ECLS to treat the post-traumatic shock/CA presenting during (n = 2) or
following (n = 3) damage-control surgeries for initial trauma, and another 4 patients were supported
for non-surgical complications associated with initial trauma. VA-ECLS was terminated in 2 non-
survivors owing to uncontrolled hemothorax or retroperitoneal hemorrhage. Three patients survived
to hospital discharge. All of them received damage-control surgeries for initial trauma and
experienced a complicated hospitalization after weaning off VA-ECLS.
CONCLUSION:
Using VA-ECLS to treat post-traumatic shock/CA is challenging and requires multidisciplinary
expertise.