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ECMO in trauma

This episode is all about ECMO in trauma – not the usual ARDS, TRALI VV-ECMO – we’re talking about VA ECMO for the acutely dying trauma patient. Zack interviews Pål Ager-Wick from Tromso Norway, and Magnus Larsson from the Karolinska Institute in Stockholm. We talk about everything from how ECMO helps the hemorrhaging trauma patient to the futuristic “Emergency Preservation and Resuscitation” concept being done in Baltimore now.

Photo used with permission of SAMU of Paris

Bullet Points:

• VV ECMO –
  • Marginal data suggests ECMO beneficial in ARDS (CESAR, ANZECMO trials)
  • ARDS and TRALI in trauma is a reasonable extension of this
• Damage Control Surgery –
  • focus on coagulation
  • stop major bleeders and then take to ICU
  • lethal triad of coagulation includes hypothermia, dilution of coagulation factors and acidosis
• Coagulation of trauma: ECMO can improve all three components of lethal triad
• Heparin has been successfully withheld in bleeding trauma patients
• ECMO in Severe Chest Trauma – 10 patients, 8 ruptured cardiac chambers¹
• Blunt cardiac arrest – a case report²
• Bleeding less than 15% mortality after 1995, Intracranial hemorrhage patients can survive. In fact none of the ICH patients on ECMO who died died of brain bleeding (60-93% survived). Survival was 42-63% for VA ECMO. Lower ACT (<180 sec)³
• ELSO – VA ECMO in trauma – 45% survival⁴
• ECMO reduces venous pressure which may be beneficial in hemorrhaging patients⁵
• Tisherman – Suspended Animation: Emergency Preservation and Resuscitation⁶⁷⁸

Magnus Larsson