Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients

• Published in: The American journal of surgery 1995-05, Vol.169 (5), p.488-491
• Main Authors: Perchinsky, Michael J., Long, William B., Hill, Jonathan G., Parsons, James A., Bennett, John B.
• Format: Article
• Language: English
• Subjects: Acidosis; Anticoagulants; Biological and medical sciences; Bonding; Cardiopulmonary Resuscitation; Centrifugal pumps; Circuits; Combined Modality Therapy; Complications; Extracorporeal Membrane Oxygenation - methods; Female; Femoral artery; Femur; Heat exchangers; Hemorrhage - etiology; Hemorrhage - mortality; Hemorrhage - therapy; Heparin; Heparin - administration & dosage; Humans; Hypothermia; Hypovolemia; Hypoxemia; Injuries; Injury Severity Score; Life Support Care; Lung Diseases - etiology; Lung Diseases - mortality; Lung Diseases - therapy; Lung Injury; Male; Medical sciences; Metabolic acidosis; Metabolism; Middle Aged; Multiple Trauma - complications; Multiple Trauma - mortality; Multiple Trauma - therapy; Postoperative Care; Resuscitation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survivability; Survival Rate; Wounds and Injuries - complications; Wounds and Injuries - mortality; Wounds and Injuries - therapy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)80201-3

Patients who have massive but potentially survivable injuries frequently die from complications of hypovolemia, hypoxemia, hypothermia, metabolic acidosis, and coagulopathy. Emergency cardiopuhnonary bypass has been unsuccessful in preventing such deaths because it involves systemic anticoagulation that exacerbates coagulopathy. A simplified extracorporeal cardiopuhnonary life support (ECLS) system was assembled consisting of a centrifugal pump head, heat exchanger, membranous oxygenator, percutaneous cannulas, and heparin-bonded circuitry. The entire system has heparin-bonded surfaces. Patients were resuscitated with the system after femoral vein-femoral artery cannulation. ECLS was used to resuscitate massively injured patients who were deteriorating despite maximal conventional therapy. While receiving maximal conventional therapy, 6 patients developed hypothermia, metabolic acidosis, and coagulopathy causing pulmonary hemorrhaging and hypoxemia from severe underlying lung injuries. ECLS with heparin-bonded circuitry provided cardiopulmonary support and rewarming while physicians addressed coagulopathies and surgical bleeding and assessed survivability. Three patients survived. ECLS with heparin-bonded circuitry offers supplemental capability in the resuscitation and cardiopuhnonary support of selected massively injured patients while their primary injuries are being evaluated and treated.