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Temporary extracorporeal membrane oxygenation in the treatment of acute traumatic lung injury

Abstract

Purpose

To report two cases of acute life-threatening traumatic lung injury, who required temporary extracorporeal veno-venous membrane oxygenation (ECMO), and airlifting to a level l trauma centre.

Clinical features

The first patient suffered a severe motor vehicle accident with prolonged entrapment in the wreckage. After extrication, tracheal intubation, and fluid resuscitation, respiratory therapy failed to result in sufficient ventilation and oxygenation within the first hours after trauma due to severe lung contusion and intraparenychmal bleeding.

The second patient was hit by a falling tree and suffered isolated blunt chest trauma. Due to pulmonary contusions and tracheal rupture, subsequent ventilation management was limited by extensive mediastinal emphysema. Both patients were airlifted to a University Hospital and placed on ECMO for four and six days without complications, respectively. After emergency surgery and 21 and 26 days intensive care treatment, both patients were transferred to a general ward, and discharged from the hospital with full recovery.

Conclusion

These cases demonstrate the role of ECMO in the treatment of traumatic respiratory failure. If ventilatory support strategies fail due to severe lung or airway injury, ECMO may be an option for the temporary management of gas exchange in trauma patients.

Résumé

Objectif

Rapporter deux cas d’atteinte pulmonaire traumatique, mettant la vie en danger, qui ont nécessité une oxygénation extracorporelle (OEC) veino-veineuse et un transport aérien vers un centre de traumatologie de premier niveau.

Aspects cliniques

Le premier patient a été victime d’un sévère accident d’automobile où il est resté coincé pendant une longue période. Après avoir été dégagé, on a procédé à une intubation endotrachéale et à une réanimation volémique, mais la thérapie respiratoire n’a pu fournir une ventilation et une oxygénation suffisantes pendant les premières heures qui ont suivi le traumatisme à cause des contusions pulmonaires sévères et du saignement intraparenchymateux. Le second patient a été blessé par la chute d’un arbre et a subi un traumatisme thoracique isolé. La présence de contusions pulmonaires et d’une rupture de la trachée a limité le traitement subséquent par ventilation en causant un emphysème médiastinal important. Les deux patients ont été transportés par avion vers un hôpital universitaire et placés sous OEC pendant quatre et six jours respectivement et ce, sans complication. Suivant une chirurgie d’urgence et 21 et 26 jours de traitement à l’unité des soins intensifs, les deux patients ont été déplacés à l’unité des soins généraux et ils ont quitté l’hôpital complètement rétablis.

Conclusion

Ces cas démontrent le rôle de l’OEC dans le traitement d’une défaillance respiratoire traumatique. Si les stratégies de soutien respiratoire ne réussissent pas à cause de lésion sévère des poumons ou des voies aériennes, l’OEC peut se présenter comme un choix de traitement temporaire des échanges gazeux chez les patients victime d’un traumatisme.

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Correspondence to Wolfgang Voelckel.

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Voelckel, W., Wenzel, V., Rieger, M. et al. Temporary extracorporeal membrane oxygenation in the treatment of acute traumatic lung injury. Can J Anaesth 45, 1097–1102 (1998). https://doi.org/10.1007/BF03012399

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Keywords

  • Emergency Medical Service
  • Trauma Centre
  • Chest Tube
  • Adult Respiratory Distress Syndrome
  • Emergency Medical Service Helicopter