Is extracorporeal cardiopulmonary resuscitation practical in severe chest trauma? A systematic review in single center of developing country


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Abstract

BACKGROUNDWe report our experience with extracorporeal cardiopulmonary resuscitation (ECPR) in patients with rupture of heart and major vessels caused by severe chest trauma.METHODSFrom April 2015 to May 2016, 10 patients with suspected injuries to the heart and major vessels after focused assessment with sonography in trauma or computed tomography were selected from patients admitted at a Level I trauma center presenting with cardiac tamponade and tension hemothorax due to severe chest trauma. Patients were divided as follow: group A (n = 3), patients without cardiac arrest before entering the operating theatre; group B (n = 5), patients with cardiac arrest for whom ECPR was applied, and group C (n = 2), patients with cardiac arrest for whom ECPR was not applied.RESULTSAll patients underwent exploratory thoracotomy or sternotomy. Injuries included cardiac chamber ruptures (n = 8), lesions in the internal mammary arteries (n = 1), and lesions of the bronchial arteries (n = 1). In group B, extracorporeal membrane oxygenation (ECMO) was initiated and circulation was restored promptly with adequate extracorporeal blood flow in all five cases. These patients were weaned off ECMO uneventfully after controlling the bleeding in the operating theatre. Mean ECMO time was 142 ± 48.2 minutes. Conversely, both patients in group C died, one due to low cardiac output on postoperative day 1, and the other due to multiple-organ failure on postoperative day 7.CONCLUSIONECPR may be an option to rescue and stabilize patients with cardiac arrest due to severe chest trauma.LEVELS OF EVIDENCETherapeutic/Care Management, Level V.

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