Acute Crit Care.  2019 Aug;34(3):223-227. 10.4266/acc.2016.00472.

Long-term extracorporeal membrane oxygenation after severe blunt traumatic lung injury in a child

• Lee OJ
• Cho YH
• Hwang J
• Yoon I
• Kim YH
• Cho J

• KMID: 2457682
• DOI: http://doi.org/10.4266/acc.2016.00472

Abstract

Managing acute respiratory distress syndrome (ARDS) after severe blunt traumatic lung injury can be challenging. In cases where patients are refractory to conventional therapy, extracorporeal membrane oxygenation (ECMO) should be considered. In addition, the heparin-coated circuit can reduce hemorrhagic complications in patients with multiple traumas. Although prolonged ECMO may be necessary, excellent outcomes are frequently associated. In this study, we report long-term support with venovenous-ECMO applied in a child with severe blunt trauma in Korea. This 10-year-old and 30-kg male with severe blunt thoracic trauma after a car accident developed severe ARDS a few days later, and ECMO was administered for 33 days. Because of pulmonary hemorrhage during ECMO support, heparin was stopped for 3 days and then restarted. He was weaned from ECMO successfully and has been able to run without difficulty for the 2 years since discharge.

Keyword

acute respiratory distress syndrome; extracorporeal membrane oxygenation; pediatrics; thoracic injuries

MeSH Terms

Child*
Extracorporeal Membrane Oxygenation*
Hemorrhage
Heparin
Humans
Korea
Lung Injury*
Lung*
Male
Multiple Trauma
Pediatrics
Respiratory Distress Syndrome, Adult
Thoracic Injuries
Heparin

Figure

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  Figure 1. A Chest radiograph on admission. Bilateral pneumothorax and pneumomediastinum (A), and an image after bilateral closed thoracotomy (B). (C) Chest computed tomography on the day of admission. Extensive lung contusion of both lungs with left hemothorax, right pneumothorax, and pneumomediastinum.

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  Figure 2. Chest radiograph on day 0 of extracorporeal membrane oxygenation.

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  Figure 3. Chest radiograph 23 days after ECMO removal. ECMO: extracorporeal membrane oxygenation.

Reference

1. Peclet MH, Newman KD, Eichelberger MR, Gotschall CS, Garcia VF, Bowman LM. Thoracic trauma in children: an indicator of increased mortality. J Pediatr Surg. 1990; 25:961–5.

2. Schuerer DJ, Kolovos NS, Boyd KV, Coopersmith CM. Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement. Chest. 2008; 134:179–84.

3. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307:2526–33.

4. Wu MY, Lin PJ, Tseng YH, Kao KC, Hsiao HL, Huang CC. Venovenous extracorporeal life support for posttraumatic respiratory distress syndrome in adults: the risk of major hemorrhages. Scand J Trauma Resusc Emerg Med. 2014; 22:56.

5. Madershahian N, Wittwer T, Strauch J, Franke UF, Wippermann J, Kaluza M, et al. Application of ECMO in multitrauma patients with ARDS as rescue therapy. J Card Surg. 2007; 22:180–4.

6. Wiktor AJ, Haft JW, Bartlett RH, Park PK, Raghavendran K, Napolitano LM. Prolonged VV ECMO (265 Days) for ARDS without technical complications. ASAIO J. 2015; 61:205–6.

7. Toomasian JM, Snedecor SM, Cornell RG, Cilley RE, Bartlett RH. National experience with extracorporeal membrane oxygenation for newborn respiratory failure: data from 715 cases. ASAIO Trans. 1988; 34:140–7.

8. Brogan TV, Thiagarajan RR, Rycus PT, Bartlett RH, Bratton SL. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med. 2009; 35:2105–14.

9. Phillips SJ, Zeff RH, Kongtahworn C, Skinner JR, Toon RS, Grignon A, et al. Percutaneous cardiopulmonary bypass: application and indication for use. Ann Thorac Surg. 1989; 47:121–3.

10. Perchinsky MJ, Long WB, Hill JG, Parsons JA, Bennett JB. Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients. Am J Surg. 1995; 169:488–91.

11. Michaels AJ, Schriener RJ, Kolla S, Awad SS, Rich PB, Reickert C, et al. Extracorporeal life support in pulmonary failure after trauma. J Trauma. 1999; 46:638–45.

12. Arlt M, Philipp A, Voelkel S, Rupprecht L, Mueller T, Hilker M, et al. Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock. Resuscitation. 2010; 81:804–9.

13. Muellenbach RM, Kredel M, Kunze E, Kranke P, Kuestermann J, Brack A, et al. Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury. J Trauma Acute Care Surg. 2012; 72:1444–7.

14. Swaniker F, Kolla S, Moler F, Custer J, Grams R, Bartlett R, et al. Extracorporeal life support outcome for 128 pediatric patients with respiratory failure. J Pediatr Surg. 2000; 35:197–202.

15. Fortenberry JD, Meier AH, Pettignano R, Heard M, Chambliss CR, Wulkan M. Extracorporeal life support for posttraumatic acute respiratory distress syndrome at a children’s medical center. J Pediatr Surg. 2003; 38:1221–6.