World Journal of Surgery

, Volume 42, Issue 8, pp 2398–2403 | Cite as

Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) for Acute Respiratory Failure Following Injury: Outcomes in a High-Volume Adult Trauma Center with a Dedicated Unit for VV ECMO

  • Jay Menaker
  • Ronald B. Tesoriero
  • Ali Tabatabai
  • Ronald P. Rabinowitz
  • Christopher Cornachione
  • Terence Lonergan
  • Katelyn Dolly
  • Raymond Rector
  • James V. O’Connor
  • Deborah M. Stein
  • Thomas M. Scalea
Original Scientific Report



The use of veno-venous extracorporeal membrane oxygenation (VV ECMO) has increased over the past decade. The purpose of this study was to evaluate outcomes in adult trauma patients requiring VV ECMO.


Data were collected on adult trauma patients admitted between January 1, 2015, and November 1, 2016. Demographics, injury-specific data, ECMO data, and survival to discharge were recorded. Medians [interquartile range (IQR)] were reported. A p value ≤0.05 was considered statistically significant.


Eighteen patients required VV ECMO during the study period. Median age was 28.5 years (IQR 24–43). Median injury severity score (ISS) was 27 (IQR 21–41); median PaO2/FiO2 (P/F) prior to ECMO cannulation was 61 (IQR 50–70). Median time from injury to cannulation was 3 (IQR 0–6) days. Median duration of ECMO was 266 (IQR 177–379) hours. Survival to discharge was 78%. Survivors had a significantly higher ISS (p = 0.03), longer intensive care unit length of stay (ICU LOS) (p < 0.0004), hospital LOS (p < 0.000004), and time on the ventilator (p < 0.0003). Median time of injury to cannulation was significantly longer in patients who survived to discharge (p = 0.01). There was no difference in P/F ratio prior to cannulation (p = ns).


We have demonstrated improved outcome of patients requiring VV ECMO following injury compared to historical data. Although shorter time from injury to cannulation for VV ECMO was associated with death, select patients who meet criteria for VV ECMO early following injury should be referred/transferred to a tertiary care facility that specializes in trauma and ECMO care.


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to report and no disclosures to report.


  1. 1.
    Center for Disease Control. Injury Prevention and Control. Ten leading causes of death and Injury 2015. Accessed 18 Oct 2017
  2. 2.
    Tisherman SA, Schmicker RH, Brasel KJ, Bulger EM, Kerby JD, Minei JP et al (2015) Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the Resuscitation Outcomes Consortium. Ann Surg 261(3):586–590CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Navarrete-Navarro P, Rodriguez A, Reynolds N, West R, Rivera R, Scalea T (2001) Adult respiratory distress syndrome among blunt and penetrating trauma patients: demographics, mortality, and resource utilization over 8 years. J Crit Care 16:47–53CrossRefPubMedGoogle Scholar
  4. 4.
    Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A, ARDS Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308CrossRefPubMedGoogle Scholar
  5. 5.
    Papazain L, Forel JM, Gacoui A, Penot-Ragon C, Perrin G, Loundou A et al (2010) Neuromuscular blocker in early acute respiratory distress syndrome. N Engl J Med 363:1107–1116CrossRefGoogle Scholar
  6. 6.
    Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T et al (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168CrossRefPubMedGoogle Scholar
  7. 7.
    Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH et al (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA 242:2193–2196CrossRefPubMedGoogle Scholar
  8. 8.
    Morris AH, Wallace CJ, Menlove RL, Clemmer TP, Orme JF Jr, Weaver LK et al (1994) Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 149(2 Pt 1):295–305CrossRefPubMedGoogle Scholar
  9. 9.
    Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363CrossRefPubMedGoogle Scholar
  10. 10.
    Cianchi G, Bonizzoli M, Pasquini A, Bonacchi M, Zagli G, Ciapetti M et al (2011) Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center. BMC Pulm Med 11:1–9CrossRefGoogle Scholar
  11. 11.
    Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators et al (2009) Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA 302:1888–1895CrossRefPubMedGoogle Scholar
  12. 12.
    Beurtheret S, Mastroianni C, Pozzi M, D’Alessandro C, Luyt CE, Combes A et al (2001) Extracorporeal membrane oxygenation for 2009 infeluenzxa A (H1N1) acute respiratory distress syndrome: single-centre experience with 1-year follow up. Eur J Cardiothorac Surg 41:691–695CrossRefGoogle Scholar
  13. 13.
    Extracorporeal Life Support Organization. ECLS Registry report. United States Summary. July 2017Google Scholar
  14. 14.
    Muellenbach RM, Kredel M, Kunze E, Kranke P, Kuestermann J, Brack A et al (2012) Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury. J Trauma Acute Care Surg 72:1444–1447CrossRefPubMedGoogle Scholar
  15. 15.
    Zonies D, Merkel M (2016) Advanced extracorporeal therapy in trauma. Curr Opin Crit Care 22(6):578–583CrossRefPubMedGoogle Scholar
  16. 16.
    Ahmad SB, Menaker J, Kufera J, OʼConnor J, Scalea TM, Stein DM (2017) Extracorporeal membrane oxygenation after traumatic injury. J Trauma Acute Care Surg 82:587–591CrossRefPubMedGoogle Scholar
  17. 17.
    Menaker J, Dolly K, Rector R, Kufera J, Lee EE, Tabatabai A et al (2017) The Lung Rescue Unit (LRU)—does a dedicated intensive care unit for veno-venous extra-corporeal membrane oxygenation (VV ECMO) improve survival to discharge? J Trauma Acute Care Surg 83:438–442CrossRefPubMedGoogle Scholar
  18. 18.
    Michaels AJ, Schriener RJ, Kolla S, Awad SS, Rich PB, Reickert C et al (1999) Extracorporeal life support in pulmonary failure after trauma. J Trauma 46:638–645CrossRefPubMedGoogle Scholar
  19. 19.
    Biderman P, Einav S, Fainblut M, Stein M, Singer P, Medalion B (2013) Extracorporeal life support in patients with multiple injuries and severe respiratory failure: a single-center experience? J Trauma Acute Care Surg 75:907–912CrossRefPubMedGoogle Scholar
  20. 20.
    Guirand DM, Okoye OT, Schmidt BS, Mansfield NJ, Aden JK, Martin RS et al (2014) 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 76:1275–1281CrossRefPubMedGoogle Scholar
  21. 21.
    Ried M, Bein T, Philipp A, Müller T, Graf B, Schmid C et al (2013) Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. Crit Care 17:R110CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Jacobs JV, Hooft NM, Robinson BR, Todd E, Bremner RM, Petersen SR, Smith MA (2015) The use of extracorporeal membrane oxygenation in blunt thoracic trauma: a study of the Extracorporeal Life Support Organization database. J Trauma Acute Care Surg 79:1049–1053CrossRefPubMedGoogle Scholar
  23. 23.
    Bosarge PL, Raff LA, McGwin G Jr, Carroll SL, Bellot SC, Diaz-Guzman E, Kerby JD (2016) Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma patients with severe adult respiratory distress syndrome. J Trauma Acute Care Surg 81:236–243CrossRefPubMedGoogle Scholar
  24. 24.
    Cordell-Smith JA, Roberts N, Peek GJ, Firmin RK (2006) Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO). Injury 37:29–32CrossRefPubMedGoogle Scholar
  25. 25.
    Riccabona M, Kuttnig-Haim M, Dacar D, Urlesberger B, Reiterer F, Maurer U, Zobel G (1997) Venous thrombosis in and after extracorporeal membrane oxygenation: detection and follow-up by color Doppler sonography. Eur Radiol 7:1383–1386CrossRefPubMedGoogle Scholar
  26. 26.
    Shafii AE, Brown CR, Murthy SC, Mason DP (2012) High incidence of upper-extremity deep vein thrombosis with dual lumen venovenous extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 144:988–989CrossRefPubMedGoogle Scholar
  27. 27.
    Brenner K, Cunningham J, Bacchetta M, Brodie D (2012) Catheter associated deep vein thrombosis and level of anticoagulation in adult patients requiring extra-corporeal membrane oxygenation for respiratory failure. Am J Respir Crit Care Med 185:A6014Google Scholar
  28. 28.
    Cooper E, Burns J, Retter A, Salt G, Camporota L, Meadows CI et al (2015) Prevalence of venous thrombosis following venovenous extracorporeal membrane oxygenation in patients with severe respiratory failure. Crit Care Med 43:e581–e584CrossRefPubMedGoogle Scholar
  29. 29.
    Menaker J, Tabatabai A, Rector R, Dolly K, Kufera J, Lee E et al (2017) Incidence of cannula associated deep vein thrombosis after veno-venous ECMO. ASAIO J 63:588–591CrossRefPubMedGoogle Scholar
  30. 30.
    Marinella MA, Kathula SK, Markert RJ (2000) Spectrum of upper extremity deep vein thrombosis in a community teaching hospital. Heart Lung 29:113–117CrossRefPubMedGoogle Scholar
  31. 31.
    Savage KJ, Wells PS, Schulz V, Goudie D, Morrow B, Cruickshank M, Kovacs MJ (1999) Outpatient use of low molecular weight heparin (Dalteparin) for the treatment of deep vein thrombosis of the upper extremity. Thromb Haemost 82:1008–1010CrossRefPubMedGoogle Scholar
  32. 32.
    Monreal M, Lafoz E, Ruiz J, Valls R, Alastrue A (1991) Upper-extremity deep vein thrombosis and pulmonary embolism: a prospective study. Chest 99:280–283CrossRefPubMedGoogle Scholar
  33. 33.
    Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ (2012) American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:7s–47sCrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Jay Menaker
    • 1
  • Ronald B. Tesoriero
    • 1
  • Ali Tabatabai
    • 1
  • Ronald P. Rabinowitz
    • 1
  • Christopher Cornachione
    • 1
  • Terence Lonergan
    • 1
  • Katelyn Dolly
    • 1
  • Raymond Rector
    • 1
  • James V. O’Connor
    • 1
  • Deborah M. Stein
    • 1
  • Thomas M. Scalea
    • 1
  1. 1.Program in TraumaR Adams Cowley Shock Trauma CenterBaltimoreUSA

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