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Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know

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Abstract

The purpose of this article is to review the spectrum of severe traumatic injuries treatable with ECMO and their imaging features, considerations for cannula placement, and complications that may arise in polytraumatized patients on extracorporeal life support. Recent major advances in miniaturization and biocompatibility of ECMO devices have dramatically increased their safety profile and expanded the application of ECMO to patients with severe polytrauma.

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References

  1. Rosenthal A, McKenney M, Sanchez R, Lee S, Carrillo EH (2009) Extracorporeal membrane oxygenation for severe hypoxemia after trauma pneumonectomy. Am Surg 75:1258–1260

    PubMed  Google Scholar 

  2. Hill JD, O’Brien TG, Murray JJ et al (1972) Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). N Engl J Med 286:629–634

    Article  CAS  PubMed  Google Scholar 

  3. Smith RS (2013) Disruptive technology in the treatment of thoracic trauma. Am J Surg 206:826–833

    Article  PubMed  Google Scholar 

  4. Arlt M, Philipp A, Voelkel S, et al. Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock. Resuscitation; 81:804–809

  5. Ried M, Bein T, Philipp A 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:R110

    Article  PubMed Central  PubMed  Google Scholar 

  6. Brederlau J, Anetseder M, Schoefinius A et al (2008) Arteriovenous extracorporeal lung assist and high frequency oscillatory ventilation in post-traumatic acute respiratory distress syndrome. J Trauma Acute Care Surg 64:E65–E68. doi:10.1097/1001.ta.0000224919.0000219519.0000224912e

    Article  Google Scholar 

  7. Nehra D, Goldstein AM, Doody DP, Ryan DP, Chang Y, Masiakos PT (2009) Extracorporeal membrane oxygenation for nonneonatal acute respiratory failure: the Massachusetts general hospital experience from 1990 to 2008. Arch Surg 144:427–432

    Article  PubMed  Google Scholar 

  8. Shanley C, Hirschl R, Schumacher R et al (1994) Extracorporeal life support for neonatal respiratory failure. A 20-year experience. Ann Surg 220:269–280

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet 1996; 348:75–82

  10. Hui DS, Lee N, Chan PKS (2010) Clinical management of pandemic 2009 influenza a(h1n1) infection. CHEST J 137:916–925

    Article  Google Scholar 

  11. Zarychanski R, Stuart TL, Kumar A et al (2010) Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection. Can Med Assoc J 182:257–264

    Article  Google Scholar 

  12. Davies A (2009) The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators. Extracorporeal membrane oxygenation for 2009 influenza A (h1n1) acute respiratory distress syndrome. JAMA 302:1888–1895

    Article  CAS  PubMed  Google Scholar 

  13. Peek GJ, Mugford M, Tiruvoipati R 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 374:1351–1363

    Article  PubMed  Google Scholar 

  14. Guirand DM, Okoye OT, Schmidt BS 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 76:1275–1281

    Article  PubMed  Google Scholar 

  15. Brederlau J, Anetseder M, Wagner R et al (2004) Pumpless extracorporeal lung assist in severe blunt chest trauma. J Cardiothorac Vasc Anesth 18:777–779

    Article  PubMed  Google Scholar 

  16. Enomoto Y, Watanabe H, Nakao S, Matsuoka T (2011) Complete thoracic tracheal transection caused by blunt trauma. J Trauma Acute Care Surg 71:1478. doi:10.1097/TA.0b013e31821bf562

    Article  Google Scholar 

  17. Madershahian N, Wittwer T, Strauch J et al (2007) Application of ECMO in multitrauma patients with ards as rescue therapy. J Card Surg 22:180–184

    Article  PubMed  Google Scholar 

  18. 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 75:907–912. doi:10.1097/TA.0b1013e3182a8334f

    Article  PubMed  Google Scholar 

  19. Joshi V, Harvey C, Nakas A, Waller D, Peek G, Firmin R (2013) The need for thoracic surgery in adult patients receiving extracorporeal membrane oxygenation: a 16-year experience. Perfusion 28:328–332

    Article  CAS  PubMed  Google Scholar 

  20. Launey Y, Flecher E, Nesseler N, Malledant Y, Seguin P (2013) Extracorporeal life support in a severe blunt chest trauma with cardiac rupture. Case Rep Crit Care 136542

  21. Muellenbach RM, Kredel M, Kunze E 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 72:1444–1447. doi:10.1097/TA.0b013e31824d68e3

    PubMed  Google Scholar 

  22. Willms D, Wachtel T, Daleiden A, Dembitsky W, Schibanoff J, Gibbons J (1994) Venovenous extracorporeal life support in traumatic bronchial disruption and adult respiratory distress syndrome using surface-heparinized equipment: case report. J Trauma 36:252–254

    Article  CAS  PubMed  Google Scholar 

  23. Liao C-H, Huang Y-K, Tseng C-N, Wu M-Y, Tsai F-C (2008) Successful use of extracorporeal life support to resuscitate traumatic inoperable pulmonary hemorrhage. J Trauma Acute Care Surg 64:E15–E17. doi:10.1097/1001.ta.0000196342.0000161425.0000196347e

    Article  Google Scholar 

  24. Michaels AJ, Schriener RJ, Kolla S et al (1999) Extracorporeal life support in pulmonary failure after trauma. J Trauma Acute Care Surg 46:638–645

    Article  CAS  Google Scholar 

  25. Dominguez TE, Mitchell M, Friess SH et al (2005) Use of recombinant factor VIIa for refractory hemorrhage during extracorporeal membrane oxygenation*. Pediatr Crit Care Med 6:348–351

    Article  CAS  PubMed  Google Scholar 

  26. Wittenstein B, Ng C, Ravn H, Goldman A (2005) Recombinant factor VII for severe bleeding during extracorporeal membrane oxygenation following open heart surgery. Pediatr Crit Care Med 6:473–476

    Article  PubMed  Google Scholar 

  27. Asmussen S, Maybauer D, Fraser J et al (2013) Extracorporeal membrane oxygenation in burn and smoke inhalation injury. Burns 39:429–435

    Article  PubMed  Google Scholar 

  28. Dreizin D, Munera F (2012) Blunt polytrauma: Evaluation with 64-section whole-body CT angiography. RadioGraphics 32:609–631

    Article  PubMed  Google Scholar 

  29. Schreiber M (2004) Damage control surgery. Crit Care Clin 20:101–118

    Article  PubMed  Google Scholar 

  30. Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B (1997) Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidosis revisited. J Trauma Acute Care Surg 42:857–862

    Article  CAS  Google Scholar 

  31. Ferrara A, MacArthur J, Wright H, Modlin I, McMillen M (1990) Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion. Am J Surg 160:515–518

    Article  CAS  PubMed  Google Scholar 

  32. Krause K, Howells G, Buhs C et al (2000) Hypothermia-induced coagulopathy during hemorrhagic shock. Am Surg 66:348–354

    CAS  PubMed  Google Scholar 

  33. Firstenberg M, Nelson K, Abel E, McGregor J, Eiferman D (2012) Extracorporeal membrane oxygenation for complex multiorgan system trauma. Case Rep Surg

  34. Daoud O, Augustin P, Mordant P, et al. Extracorporeal Membrane Oxygenation in 5 Patients With Bronchial Fistula With Severe Acute Lung Injury. Ann Thorac Surg; 92:327–330

  35. Gothner M, Buchwald D, Schlebes A, Strauch JT, Schildhauer TA, Swol J (2013) Use of extracorporeal membrane oxygenation in combination with high-frequency oscillatory ventilation in post-traumatic ARDS. Acta Anaesthesiol Scand 57:391–394

    Article  CAS  PubMed  Google Scholar 

  36. Yuan K-C, Fang J-F, Chen M-F (2008) Treatment of endobronchial hemorrhage after blunt chest trauma with extracorporeal membrane oxygenation (ECMO). J Trauma Acute Care Surg 65:1151–1154

    Article  Google Scholar 

  37. Mohamed I, Lau CT, Bolen MA et al (2015) Building a bridge to save a failing ventricle: Radiologic evaluation of short- and long-term cardiac assist devices. RadioGraphics 35:327–356

    Article  PubMed  Google Scholar 

  38. Hirose H, Yamane K, Marhefka G, Cavarocchi N (2012) Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation. J Cardiothorac Surg 7

  39. Bisdas T, Beutel G, Warnecke G, et al. Vascular Complications in Patients Undergoing Femoral Cannulation for Extracorporeal Membrane Oxygenation Support. Ann Thorac Surg; 92:626–631

  40. Muehrcke DD, McCarthy PM, Stewart RW, et al. Complications of extracorporeal life support systems using heparin-bound surfaces: The risk of intracardiac clot formation. J Thorac Cardiovasc Surg; 110:843–851

  41. Ballouhey Q, Fesseau R, Benouaich V, Léobon B (2013) Benefits of extracorporeal membrane oxygenation for major blunt tracheobronchial trauma in the paediatric age group. Eur J Cardiothorac Surg 43:864–865

    Article  PubMed  Google Scholar 

  42. Skarda D, Henricksen J, Rollins M (2012) Extracorporeal membrane oxygenation promotes survival in children with trauma related respiratory failure. Pediatr Surg Int 28:711–714

    Article  PubMed  Google Scholar 

  43. Anderson H 3rd, Shapiro M, Delius R, Steimle C, Chapman R, Bartlett R (1994) Extracorporeal life support for respiratory failure after multiple trauma. J Trauma 37:266–272

    Article  PubMed  Google Scholar 

  44. Garlick J, Maxson T, Imamura M, Green J, Prodhan P. Differential Lung Ventilation and Venovenous Extracorporeal Membrane Oxygenation for Traumatic Bronchopleural Fistula. Ann Thorac Surg; 96:1859–1860

  45. Yen T-S, Liau C-C, Chen Y-S, Chao A. Extracorporeal membrane oxygenation resuscitation for traumatic brain injury after decompressive craniotomy. Clin Neurol Neurosurg; 110:295–297

  46. Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS (2001) Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. J Neurosurg 95:560–568

    Article  CAS  PubMed  Google Scholar 

  47. Bratton SL, Davis RL (1997) Acute lung injury in isolated traumatic brain injury. Neurosurgery 40:707–712

    Article  CAS  PubMed  Google Scholar 

  48. Campione A, Agostini M, Portolan M, Alloisio A, Fino C, Vassallo G. Extracorporeal membrane oxygenation in respiratory failure for pulmonary contusion and bronchial disruption after trauma. J Thorac Cardiovasc Surg; 133:1673–1674

  49. Schmid F, Philipp A, Link J, Zimmermann M, Birnbaum D (2002) Hybrid management of aortic rupture and lung failure: Pumpless extracorporeal lung assist and endovascular stent-graft. Ann Thorac Surg 73:1618–1620

    Article  PubMed  Google Scholar 

  50. Halonen-Watras J, O’Connor J, Scalea T (2011) Traumatic pneumonectomy: a viable option for patients in extremis. Am Surg 77:493–497

    PubMed  Google Scholar 

  51. Cordell-Smith JA, Roberts N, Peek GJ, Firmin RK. Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO). Injury; 37:29–32

  52. Coskun KO, Popov AF, Schmitto JD et al (2010) Extracorporeal circulation for rewarming in drowning and near-drowning pediatric patients. Artif Organs 34:1026–1030

    Article  PubMed  Google Scholar 

  53. Vasilyev S, Schaap RN, Mortensen JD (1995) Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units: an international, multicenter, prospective survey. CHEST J 107:1083–1088

    Article  CAS  Google Scholar 

  54. Pranikoff T, Hirschl RB, Steimle CN, Anderson HL, Bartlett RH (1997) Mortality is directly related to the duration of mechanical ventilation before the initiation of extracorporeal life support for severe respiratory failure. Crit Care Med 25:28–32

    Article  CAS  PubMed  Google Scholar 

  55. Cohn S, DuBose J (2010) Pulmonary contusion: an update on recent advances in clinical management. World J Surg 34:1959–1970

    Article  PubMed  Google Scholar 

  56. Cohn SM (1997) Pulmonary contusion: Review of the clinical entity. J Trauma Acute Care Surg 42:973–979

    Article  CAS  Google Scholar 

  57. Miller PR, Croce MA, Bee TK et al (2001) ARDS after pulmonary contusion: Accurate measurement of contusion volume identifies high-risk patients. J Trauma Acute Care Surg 51:223–230

    Article  CAS  Google Scholar 

  58. Clark G, Schecter W, Trunkey D (1988) Variables affecting outcome in blunt chest trauma: Flail chest vs. pulmonary contusion. J Trauma 28:298–304

    Article  CAS  PubMed  Google Scholar 

  59. Pierson DJ, Horton CA, Bates PW (1986) PErsistent bronchopleural air leak during mechanical ventilation. a review of 39 cases. CHEST J 90:321–323

    Article  CAS  Google Scholar 

  60. Sian K, McAllister B, Brady P. The Use of Extracorporeal Membrane Oxygenation Therapy in the Delayed Surgical Repair of a Tracheal Injury. Ann Thorac Surg; 97:338–340

  61. Korvenoja P, Pitkänen O, Berg E, Berg L. Veno-Venous Extracorporeal Membrane Oxygenation in Surgery for Bronchial Repair. Ann Thorac Surg; 86:1348–1349

  62. Wiebe K, Poeling J, Arlt M, et al. Thoracic Surgical Procedures Supported by a Pumpless Interventional Lung Assist. Ann Thorac Surg; 89:1782–1788

  63. Barreda E, Flecher E, Aubert S, Leprince P (2007) Extracorporeal life support in right ventricular rupture secondary to blast injury. Interact Cardiovasc Thorac Surg 6:87–88

    Article  PubMed  Google Scholar 

  64. Masiakos PT, Hirsch EF, Millham FH (2003) Management of severe combined pulmonary and myocardial contusion with extracorporeal membrane oxygenation. J TraumaAcute Care Surg 54:1012–1015

    Article  Google Scholar 

  65. Dhaliwal RS, Saxena P, Puri D, Sidhu KS (2001) Role of physiological lung exclusion in difficult lung resections for massive hemoptysis and other problems. Eur J Cardiothorac Surg 20:25–29

    Article  CAS  PubMed  Google Scholar 

  66. Mateen FJ, Muralidharan R, Shinohara RT, Parisi JE, Schears GJ, Wijdicks EM (2011) Neurological injury in adults treated with extracorporeal membrane oxygenation. Arch Neurol 68:1543–1549

    Article  PubMed  Google Scholar 

  67. Rollins MD, Hubbard A, Zabrocki L, Barnhart DC, Bratton SL (2012) Extracorporeal membrane oxygenation cannulation trends for pediatric respiratory failure and central nervous system injury. J Pediatr Surg 47:68–75

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare they have no competing interests.

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Authors and Affiliations

  1. Department of Diagnostic Radiology and Nuclear Medicine, Trauma and Emergency Radiology, University of Maryland Medical Center & R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD, 21201, USA

    David Dreizin

  2. Department of Surgery, Department of Emergency Medicine (Secondary), University of Maryland School of Medicine, Baltimore, MD, USA

    Jay Menaker

  3. Lung Rescue Unit, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    Jay Menaker

  4. R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA

    Thomas M. Scalea

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  1. David Dreizin
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  2. Jay Menaker
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Correspondence to David Dreizin.

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Dreizin, D., Menaker, J. & Scalea, T.M. Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know. Emerg Radiol 22, 565–576 (2015). https://doi.org/10.1007/s10140-015-1324-7

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