1) The document discusses the role of extracorporeal life support (ECLS) in trauma patients, outlining its functions and various clinical applications. 2) It provides examples of trauma cases where ECLS may be considered, such as severe lung trauma with acute respiratory distress syndrome. 3) The conclusion is that ECLS can be lifesaving for respiratory failure secondary to ARDS in trauma patients, and its use in trauma patients with risk of bleeding without initial anticoagulation may be valid.

1. 1
Mansoor Masjedi MD
Ass. Prof. of anesthesia , Critical care consultant
Head of Trauma ICUs , Rajaee hosp.,
Shiraz University of medical sciences
Role of extracorporeal life support in
Trauma patients

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

3. Role of ECLS in Trauma patients
• A Journey
• ECMO Functions & actions
• Clinical applications
• ABCD
• How to decide to use ECMO in trauma pts
• Conclusion
www.ECCC-Dubai.com

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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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12. ECLS organization registry which started on
1990 , now houses data on near 78000 of
sickest pts imaginable & reported an overall
survival rate of 58% .
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Neonates Pediatrics
Adults
ECLS use and survival in respiratory disease

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ECLS use and survival in Cardiac disease
Neonates Pediatrics
Adults

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18. 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

20. ECMO in Trauma ? An option in tracheobronchial injury
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21. 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 ?

22. ECMO in Trauma ?

23. Positive outcomes in ARDS
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ECMO in Trauma ?

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ECMO in Trauma ? Positive outcomes in ARDS

25. 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

26. 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 ?

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

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ECMO in Trauma ?
Can you use ECLS in hemorrhagic shock ?
• 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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31. 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

33. 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)

34. 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 bilateral chest x-ray infiltrates
and profoundly increased oxygen requirement.
• What is happening?
• Would you put this pt. on ECMO ?
ECMO in Trauma ?

35. 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

36. ECMO in Trauma ?
Can you use ECLS in TBI ?
J Trauma Acute Care Surg. 2012 May;72(5):1444-7. doi: 10.1097/TA.0b013e31824d68e3.
Prolonged heparin-free extracorporeal
membrane oxygenation in multiple injured
acute respiratory distress syndrome
patients with traumatic brain injury.
Muellenbach RM1
, Kredel M, Kunze E, Kranke P, Kuestermann J, Brack A, Gorski A,
Wunder C, Roewer N, Wurmb T.
CONCLUSIONS:
Based on our experience, we recommend the use of heparin-free
ECMO in multiple injured patients with pulmonary failure that is not
successfully controlled by lung-protective ventilation even if severe
TBI is present.

37. Center of ECMO in south of Iran

38. A 30 y/o male , car-pedestrian accident , with traumatic
brain injury , lung contusion & bilat. Hemothorax , Rt. Tibia &
also mandibular Fx. He undergoes a 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 traumatized pt.

39. Our experience : ECMO in a multiple traumatized pt.

40. J Card Surg. 2007 May-Jun;22(3):180-4
Application of ECMO in multitrauma patients with ARDS as rescue therapy
Madershahian N1, Wittwer T, Strauch J, Franke UF, Wippermann J, Kaluza M,
Wahlers T.
CONCLUSIONS:
Quick encouragement of ECMO for the temporary management of gas exchange
may increase survival rates in trauma patients with ARDS

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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

42.  Data on ECLS from1989 – 2016
 78,397 pts with 58% survival to hospital discharge
 ECLS use and centers providing ECLS have increased worldwide
 largest growth in adult respiratory and cardiac failure
 Indications are expanding, especially in children & adult CPR (ECPR)
 Adverse events during the course of ECLS are common and underscore the
need for skilled ECLS management & appropriately trained ECLS personnel &
teams

43. • From all ECMO implantations , all over the world , up to now , near
100 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

44. • ECLS is not contraindicated in trauma
• A multidisciplinary and specialized approach
• Surgical procedures are possible under ECMO
• Carefully selected patients
• More regional studies and deeper analysis of
national and international registries
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