(1747) Successful Use of Extracorporeal Membranous Oxygenation in Blunt Trauma: A Case Report

Introduction: The use of extracorporeal membranous oxygenation (ECMO) to support cardiopulmonary function in severe trauma is an emerging resuscitation technique. Venovenous (VV) ECMO in particular has favorable outcomes when employed for traumatic lung injury, with survival rates reported as high as 77%. Here, we describe a scenario in which a multisystem trauma patient who sustained severe blunt trauma and ultimately acquired transfusion-associated lung injury (TRALI), was cannulated for VV ECMO, and survived hospitalization.

Description: A 57-year-old male was struck by a dump truck while riding his bicycle; the truck threw him from his vehicle and subsequently crushed him beneath its wheels as it drove over his body. He sustained a Grade V splenic laceration, a left diaphragm rupture, comminuted pelvic fractures, left 1st-12th rib fractures and right 2nd-10th rib fractures with flail chest physiology, among other injuries. He was initially brought to a level II trauma center where laparotomy was performed for initial hemorrhage control. He was transferred to a Level I trauma center, where reopening laparotomy and continued resuscitation occurred.

During his first 24hours of resuscitation, the patient received 26upRBC and 22uFFP. Subsequently, he developed acute respiratory distress syndrome (ARDS) secondary to TRALI in the setting of his flail chest, with arterial blood gas revealing PaO2 32.2 and PCO2 84.0 approximately 12 hours after arrival. He was then emergently cannulated for VV ECMO, with immediate improvement in his gas exchange. He remained on ECMO for 6 days, during which time he underwent multiple procedures including abdominal re-exploration, chest tube placement, and tracheostomy. He was ultimately decannulated from VV ECMO on hospital day 7. After a lengthy, 69-day hospital course, he ambulated out of the hospital on discharge.

Discussion: This case exemplifies the beneficial use of VV ECMO as an adjunct to trauma resuscitation in blunt traumatic injury. Without VV ECMO, the patient presented herein would certainly have succumbed to his injuries within the first 24hours of hospitalization. As support grows for the use of VV ECMO in traumatic injury, the critical care community should strive to improve access to and study outcomes from this unique patient population.