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Justyna Swol, Christopher Marschall, Justus T Strauch, Thomas A Schildhauer
INTRODUCTION: Increasing the hematocrit is considered to increase oxygen delivery to the patient, especially when hypoxic conditions exist and the patient may become more stable. The aim of this study was to evaluate the relationship between hematocrit and hospital mortality via subgroup analyses of trauma and non-trauma patients. METHODS: The hospital length of stay (LOS) and LOS in the intensive care unit (ICU) and hospital after extracorporeal life support (ECLS) treatment of 81 patients were analyzed and compared...
April 1, 2018: Perfusion
David Macku, Pavel Hedvicak, John Quinn, Vladimir Bencko
Due to the hybrid warfare currently experienced by multiple NATO coalition and NATO partner nations, the tactical combat casualty care (TCCC) paradigm is greatly challenged. One of the major challenges to TCCC is the ad hoc extension phase in resource-poor environments, referred to as prolonged field care (PFC) and forward resuscitative care (FRC). The nuanced clinical skills with limited resources required by warfighters and auxiliary health care professionals to mitigate death on the battlefield and prevent morbidity and mortality in the PFC phase represent a balance that is still under review...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
David Zonies, Matthias Merkel
PURPOSE OF REVIEW: The purpose is to review the current application of extracorporeal life support (ECLS) in trauma patients. In addition, programmatic development is described. RECENT FINDINGS: ECLS use is increasing among trauma patients. Several recent studies among trauma patients report survival rates of 65-79%. Despite the high bleeding risk, extracorporeal membrane oxygenation (ECMO) may be safely implemented in trauma patients based on a strict protocol-driven policy...
December 2016: Current Opinion in Critical Care
David Zonies
Extracorporeal life support has evolved considerably over the past two decades. Once considered as salvage or experimental therapy in adults, extracorporeal membrane oxygenation (ECMO) is evolving into a mainstream treatment for adult critical care. This is especially true in trauma and high-risk surgical patients, who have traditionally been excluded from consideration. Several technological advances have made this possible. This includes anticoagulant-bonded circuits, device miniaturization, servo-regulated centrifugal systems, and more efficient oxygenators...
May 2017: World Journal of Surgery
Nicolas J Prat, Andrew D Meyer, Thomas Langer, Robbie K Montgomery, Bijaya K Parida, Andriy I Batchinsky, Andrew P Cap
BACKGROUND: Over 32% of burned battlefield causalities develop trauma-induced hypoxic respiratory failure, also known as acute respiratory distress syndrome (ARDS). Recently, 9 out of 10 US combat soldiers' survived life-threatening trauma-induced ARDS supported with extracorporeal membrane oxygenation (ECMO), a portable form of cardiopulmonary bypass. Unfortunately, the size, incidence of coagulation complications, and the need for systematic anticoagulation for traditional ECMO devices have prevented widespread use of this lifesaving technology...
December 2015: Shock
Launey Yoann, Flecher Erwan, Nesseler Nicolas, Malledant Yannick, Seguin Philippe
This report presents a case of severe blunt chest trauma secondary to a horse riding accident with resultant free-wall rupture of the left ventricle in association with severe lung contusion. We describe the initial surgical and medical management of the cardiac rupture which was associated with a massive haemoptysis due to severe lung trauma. Extra corporeal membrane oxygenation (ECMO) support was initiated and allowed both the acute heart and lung failure to recover. We discuss the successful use and pitfalls of ECMO techniques which are sparsely described in such severe combined cardiac and thoracic trauma...
2013: Case Reports in Critical Care
Derek M Guirand, Obi T Okoye, Benjamin S Schmidt, Nicky J Mansfield, James K Aden, R Shayn Martin, Ramon F Cestero, Michael H Hines, Thomas Pranikoff, Kenji Inaba, Jeremy W Cannon
BACKGROUND: Venovenous extracorporeal life support (VV ECLS) has been reported in adult trauma patients with severe respiratory failure; however, ECLS is not available in many trauma centers, few trauma surgeons have experience initiating ECLS and managing ECLS patients, and there is currently little evidence supporting its use in severely injured patients. This study seeks to determine if VV ECLS improves survival in such patients. METHODS: Data from two American College of Surgeons-verified Level 1 trauma centers, which maintain detailed records of patients with acute hypoxemic respiratory failure (AHRF), were evaluated retrospectively...
May 2014: Journal of Trauma and Acute Care Surgery
Yuan-His Tseng, Tzu-I Wu, Yuan-Chang Liu, Pyng-Jing Lin, Meng-Yu Wu
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...
2014: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Philippe Biderman, Sharon Einav, Michael Fainblut, Michael Stein, Pierre Singer, Benjamin Medalion
BACKGROUND: The use of extracorporeal life support in trauma casualties is limited by concerns regarding hemorrhage, particularly in the presence of traumatic brain injury (TBI). We report the use of extracorporeal membrane oxygenation (ECMO)/interventional lung assist (iLA) as salvage therapy in trauma patients. High-flow technique without anticoagulation was used in patients with coagulopathy or TBI. METHODS: Data were collected from all adult trauma patients referred to one center for ECMO/iLA treatment owing to severe hypoxemic respiratory failure...
November 2013: Journal of Trauma and Acute Care Surgery
Yves Durandy
For decades, extracorporeal life support (ECLS) systems have relied on pumps designed for short-term cardiopulmonary bypass. In the past, occlusive roller pumps were the standard. They are being progressively replaced by centrifugal pumps and devices developed specifically for ECLS. However, the ideal pump for long-term bypass is yet to be created. One interesting alternative is the Rhône-Poulenc 06 pump that is a nonocclusive pressure-regulated blood pump developed in France in the 1970s. This pump is composed of a double-stage rotor with three rollers at each level...
January 2013: Artificial Organs
Thomas Bein, David Zonies, Alois Philipp, Markus Zimmermann, Erik C Osborn, Patrick F Allan, Michael Nerlich, Bernhard M Graf, Raymond Fang
BACKGROUND: Advances in oxygenator membrane, vascular cannula, and centrifugal pump technologies led to the miniaturization of extracorporeal lung support (ECLS) and simplified its insertion and use. Support of combat injuries complicated by severe respiratory failure requires critical care resources not sustainable in the deployed environment. In response to this need, a unique international military-civilian partnership was forged to create a transportable ECLS capability to rescue combat casualties experiencing severe respiratory failure...
December 2012: Journal of Trauma and Acute Care Surgery
Cindy S Barrett, James J Jaggers, E Francis Cook, Dionne A Graham, Satish K Rajagopal, Christopher S Almond, John D Seeger, Peter T Rycus, Ravi R Thiagarajan
BACKGROUND: Advances in centrifugal blood pump technology have led to increased use of centrifugal pumps in extracorporeal membrane oxygenation (ECMO) circuits. Their efficacy and safety in critically ill neonates remains unknown. Blood cell trauma leading to hemolysis may result in end-organ injury in critically ill neonates receiving centrifugal pump ECMO. We hypothesized that neonates undergoing ECMO support using centrifugal pumps were at increased odds of hemolysis and subsequent end-organ injury...
November 2012: Annals of Thoracic Surgery
Michael D Rollins, Ania Hubbard, Luke Zabrocki, Douglas C Barnhart, Susan L Bratton
BACKGROUND: Guidelines regarding arterial cannula site and cannula site-specific risks of central nervous system (CNS) injury for pediatric patients requiring extracorporeal membrane oxygenation (ECMO) support are lacking. We reviewed cannulation trends for pediatric respiratory failure and evaluated CNS complication rates by cannulation site and mode of support. METHODS: The Extracorporeal Life Support Organization (ELSO) registry was queried for all pediatric respiratory failure patients <18 years treated from 1993-2007...
January 2012: Journal of Pediatric Surgery
Adriano Peris, Giovanni Cianchi, Simona Biondi, Manuela Bonizzoli, Andrea Pasquini, Massimo Bonacchi, Marco Ciapetti, Giovanni Zagli, Simona Bacci, Chiara Lazzeri, Pasquale Bernardo, Erminia Mascitelli, Guido Sani, Gian Franco Gensini
INTRODUCTION: Extracorporeal Life Support (ECLS) and extracorporeal membrane oxygenation (ECMO) have been indicated as treatment for acute respiratory and/or cardiac failure. Here we describe our first year experience of in-hospital ECLS activity, the operative algorithm and the protocol for centralization of adult patients from district hospitals. METHODS: At a tertiary referral trauma center (Careggi Teaching Hospital, Florence, Italy), an ECLS program was developed from 2008 by the Emergency Department and Heart and Vessel Department ICUs...
2010: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
M C W Lam, P T Yang, P W Skippen, N Kissoon, E D Skarsgard
We report three paediatric cases, and summarise the reported experience in two others, with cardiorespiratory failure requiring extracorporeal life support for which supportive pump flows could not be maintained due to abdominal compartment syndrome. In two of our patients, the mechanism of abdominal compartment syndrome was massive intra-abdominal fluid extravasation secondary to sepsis, while in the third, the mechanism was post-traumatic intra-abdominal haemorrhage. Although all three children eventually died, decompressive laparotomy and arrest of haemorrhage in the trauma patient restored venous return and enabled technically adequate extracorporeal life support...
September 2008: Anaesthesia and Intensive Care
Paul Maggio, Mark Hemmila, Jonathan Haft, Robert Bartlett
BACKGROUND: Massive pulmonary embolism is frequently lethal because of acute irreversible pulmonary and cardiac failure. Extracorporeal life support (ECLS) has been used for cardiopulmonary failure in our institution since 1988, and we reviewed our experience with its use in the management of massive pulmonary emboli. METHODS: We reviewed our complete experience with ECLS for massive pulmonary emboli from January 1992 through December 2005. The records of 21 patients were examined and data extracted...
March 2007: Journal of Trauma
Saqib Masroor, Hasan Tehrani, Si Pham, Toni Neijman, Ricardo Martinez-Ruiz, Mark McKenney, Tomas Salerno
No abstract text is available yet for this article.
August 2004: Journal of Trauma
Hwan Sung Lee, Yang Rae Rho, Hyuk Soo Lee, Chang Mo Hwang, Seong Wook Choi, Jung Chan Lee, Hyuk Choi, Sang Su Ahn, Kyung Sun, Ho Sung Son, Kwang Je Baek, Yong Soon Won, Byoung Goo Min
Extracorporeal life support (ECLS) systems have been increasingly applied to groups of patients with cardiorespiratory failure, including pediatric and adult patients with respiratory failure. Current pulsatile ECLS systems use a single pulsatile blood pump that generates a high inlet pressure in the membrane oxygenator. To minimize this high inlet pressure, we have developed a new and improved ECLS system, twin pulse life support (T-PLS). To analyze the advantages of T-PLS, we have compared T-PLS with a single pulsatile ECLS system...
2003: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
James D Fortenberry, Andreas H Meier, Robert Pettignano, Michael Heard, C Robert Chambliss, Mark Wulkan
BACKGROUND: Primary traumatic injury was considered previously a contraindication for institution of extracorporeal life support because of high risk for persistent or new bleeding. Published experience in adults suggests that extracorporeal membrane oxygenation (ECMO) can successfully support trauma victims with pulmonary failure. The authors reviewed their experience with the use of ECMO in pediatric and adult trauma patients with acute respiratory distress syndrome (ARDS) at a children's medical center...
August 2003: Journal of Pediatric Surgery
Giles J Peek, Hilliary M Killer, Richard Reeves, Andrezj W Sosnowski, Richard K Firmin
Silicone oxygenators are the standard devices used for Extracorporeal Life Support (ECLS), but they have some limitations. Microporous polypropylene hollow fiber oxygenators overcome many of these problems but, unfortunately, develop plasma leak. Polymethyl-pentene (PMP) is a novel oxygenator material. We report our initial experience with the Medos Hilite 7000LT, a PMP hollow fiber oxygenator, in six adult respiratory ECLS patients with these characteristics: age, mean 32.2 (+/-13) years; weight, mean 81.2 (+/-17) kg; PaO2/FIO2, mean 62...
September 2002: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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