1) The document discusses the emerging role of extracorporeal membrane oxygenation (ECMO) in treating patients in trauma intensive care units. 2) ECMO can be a lifesaving treatment for respiratory failure and severe hypoxemic respiratory failure secondary to acute respiratory distress syndrome in trauma patients. 3) While experience with ECMO in trauma patients is still limited, it shows promise as a rescue therapy for severe cases when implemented by a multidisciplinary team in specialized centers.

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Mansoor Masjedi MD
Associate Prof. of anesthesia & intensive care
Head of Trauma ICUs , Rajaee hosp.,
Shiraz University of medical sciences , Iran
4-6 April 2019
ECMO
& it’s emerging role in
trauma ICU

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Everything runs beautifully …
Suddenly , there is a huge crash

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Lung trauma & ARDS Hepatic trauma &
ischemia reperfusion
generalized
hypoxia
Situation is worst in the Lungs
Acute Renal ischemia &
hypoperfusion
There is no Oxygen

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10. www.ECCC-Dubai.com
I have no conflict of interest

11. ECMO & it’s emerging role in trauma ICU
• An space journey
• ECMO functions & actions
• ELSO
• ABCD
• How to decide to use ECMO in trauma pts
• Conclusion
www.ECCC-Dubai.com

12. ECLS organization registry which started on
1989 , now houses data on near 80’000 of
sickest pts imaginable & reported an overall
survival rate of 58% .
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16. ECMO in Trauma ?
A 27 y/o male is in a high speed motor – vehicle crash , has
hemoptysis , profound hypoxemia , pneumothorax with Fallen
lung sign & a massive air leak from his Lt. Chest tube .
• What is happening?
• Would you put this pt. on ECMO ?

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ECMO in Trauma ? An option in tracheobronchial injury

18. ECMO in Trauma ? An option in tracheobronchial injury
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19. An 18 y/o male sustained multiple gunshot went through
mandible , neck and chest . He is hemodynamically stable but
he has aspirated a large amount of blood & gastric contents.
He is intubated but Spo2 is 82% on 100% FiO2 .
• What is happening?
• Would you put this pt. on ECMO ?
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ECMO in Trauma ?

20. ECMO in Trauma ?

21. Positive outcomes in ARDS
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ECMO in Trauma ?

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ECMO in Trauma ? Positive outcomes in ARDS

23. ECMO in Trauma ?
Conclusion:
Pumpless and pump-driven ELS systems are an excellent treatment option in
severe thoracic trauma pts with ALF and facilitate survival in an experienced trauma center
with an interdisciplinary treatment approach.
We encourage the use of vv-ECMO due to
reduced complication rates,
better oxygenation &
best short-term outcome

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CONCLUSION:
vv-ECMO can be lifesaving in respiratory failure
&
Is a rescue Rx for severe hypoxemic respiratory failure
2ndary to ARDS in trauma pts
For pts with a high risk of bleeding, the use of ECMO with no
initial anticoagulation could be considered a valid option

25. A 43 y/o male with cirrhosis sustains a fall from height. CT reveals a
grade 4 liver laceration with extension towards the hepatic veins .
Following CT , his abdomen distends and he has transient fall in
blood pressure. His FAST is positive .
• What is happening?
• Would you put this pt. on ECMO ?
ECMO in Trauma ?

26. • Smaller systems
• Centrifugal pumps with
Low priming volume
• Smaller cannulas
• Heparin coated circuits
ECMO in Trauma ?
Can you use ECLS in hemorrhagic shock ?

27. ECMO in Trauma ?
Can you use ECLS in hemorrhagic shock ?
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• 2006 to 2009
• 10 adult trauma pts
• mean age: 32+/-14 yr
• mean ISS score 73+/-4
• (v-v) ECMO for pulmonary failure (n=7)
• (v-a) ECMO in cardiopulmonary failure (n=3)
 Prior to ECMO
 median oxygenation ratio was 47 mmHg,
 median PaCO2 was 67 mmHg
 median norepinephrine was 3 mg/h
 With ECMO
 Cardiopulmonary failure was treated effectively
 systemic gas exchange &
 blood flow improved rapidly within 2 h in all pts
 median paCO2 : 41
 60% of our patients had recovered completely

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30. Our experience : ECMO in severe hemorrhegic pt
A 36 y/o female undergone cardiac surgery due to large
pulmonary embolism , meanwhile developed massive
uncontrollable hemorrhage from pulmonary artery.
Cardiac surgeon Consulted Intensivist from OR.
• What is happening?
• Would you put this pt. on ECMO ?

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A hard and advanced team work
for more than 12 hours

32. Our experience : ECMO in severe hemorrhegic pt
• ECMO in severe pulmonary hemorrhage
• ECMO + Cardiac pump
• ECMO + Post pneumonectomy
• Pt transport to ICU with running ECMO
• ECMO assisted CPR ( ECPR)

33. A 32 y/o male who sustains a traumatic brain injury in a high speed
motor cycle crash . He undergoes a craniotomy for evacuation of
EDH . On postop day 3 , he develops bilat. C-xray infiltrates &
profoundly increased oxygen requirement.
• What is happening?
• Would you put this pt. on ECMO ?
ECMO in Trauma ?

34. ECMO in Trauma ?
Can you use ECLS in TBI ?
 Permissive hypercapnia should be avoided
 Normal ventilation goal for severe TBI pts in the absence of
cerebral herniation; PaCO2 = 35-45 mm Hg
 Maintaining SBP at
 ≥100 mm Hg for pts 50 to 69 y/o
 ≥110 mm Hg for pts 15 - 49 or > 70 y/o

37. A 30 y/o male , car-pedestrian accident , with traumatic brain injury ,
lung contusion & bilat. Hemothorax , Rt. Tibia & mandibular Fx.
He undergoes craniotomy for evacuation of ICH . Thiopental infusion
started as a modality to manage severe brain edema .
5 days later , he developed bilateral chest x-ray infiltrates and
profoundly increased oxygen requirement
What is happening?
Would you put this pt. on ECMO ?
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Our experience :
ECMO in a multiple trauma pt. ( ARDS + Brain injury)

38. Our experience :
ECMO in a multiple trauma pt. ( ARDS + Brain injury)

39. Center of ECMO in south of Iran

40. Just recently published

43.  ECLS use and centers providing ECLS have increased worldwide
 largest growth in adult respiratory and cardiac failure
 Indications are expanding
 Adverse events during the course of ECLS are common and underscore the
need for skilled ECLS management & appropriately trained ECLS personnel &
teams

44. • From all ECMO implantations , all over the world , up to now ,
limited reported ECMO in trauma pts incorporate a very small
minority of overall experience of ECLS
• There is a very small & new experience with ECMO in trauma

45. • ECLS is not contraindicated in trauma
• A multidisciplinary & specialized approach
• Surgical procedures are possible under ECMO
• Carefully selected pts
• More regional studies & deeper analysis of
national and international registries
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46. Hope to see you in shiraz - IranThanks for your patience & attention 46&