• Ralf M Muellenbach, Markus Kredel, Ekkehard Kunze, Peter Kranke, Julian Kuestermann, Alexander Brack, Armin Gorski, Christian Wunder, Norbert Roewer, and Thomas Wurmb.
• Department of Anaesthesia and Critical Care, University of Würzburg, Germany. muellenbac_r@klinik.uni-wuerzburg.de
• J Trauma Acute Care Surg. 2012 May 1;72(5):1444-7.

BackgroundExtracorporeal membrane oxygenation (ECMO) can be used as an "ultima ratio" strategy in multiple injured patients with severe thoracic trauma. However, systemic anticoagulation during ECMO is recommended and thus traumatic brain injury (TBI) and intracranial bleeding are well-accepted contraindications for ECMO therapy.MethodsThis report describes three cases of prolonged heparin-free venovenous ECMO in multiple injured acute respiratory distress syndrome patients with severe TBI failing conventional mechanical ventilation.Results: Using this strategy, neither ECMO-associated bleeding nor clotting of the extracorporeal circuit occurred. All patients survived.ConclusionsBased 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.Level Of EvidenceIV, therapeutic study.

22 keywords...

hide…