Lydia Piper, MD1, Andriy Batchinsky, MD2, Philip Mason, MD1, Matthew Read, MD1, Lloyd Tannenbaum, MD1, Christine Soohoo, MD1, James Huang, PAC1, Valerie Sams, MD1. 1SAMMC, 2USAISR
Introduction: Acute respiratory failure and acute respiratory distress syndrome (ARDS) in patients with severe thoracic or polytrauma remains difficult to treat, often resulting in high incidence of mortality or lasting morbidity. Numerous studies have shown that the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in civilian patients suffering from multiple traumas and ARDS has led to improved survival when compared to other treatment modalities. Currently ARDS affects 26-33% of critically injured combatants, often requiring aggressive early resuscitation, utilization of limited resources, and expeditious transport to higher echelons of care. While there have been several case reports of the use of extracorporeal life support (ECLS) as a rescue modality during OEF/OIF, the indications and outcomes of the ECMO population in CONUS military treatment facility has not be analyzed. In evaluating the effectiveness of ECLS transport and definitive management at a Level I Trauma Center and Burn Center within the DoD system, readiness can be improved with the goal of providing a blueprint for the future of ECLS technology development, acquisition, and deployment in combat casualty care.
Methods and Procedures: A retrospective dataset was compiled of patients who had undergone ECLS at San Antonio Military Medical Center, the only Level I Trauma Center within the DoD, and the US Army Institute of Surgical Research Burn Intensive Care Unit from 1 Jan 2012 to 24 August 2017. Demographic, pre-hospital, procedure, transport, and outcomes data were collected from hospital and transport EMR to assess clinical indications and outcomes. Primary endpoints were indication for cannulation, survival to decannulation, and survival to hospital discharge.
Results: Since the inception of the ECLS program at SAMMC, 58 inpatient and/or transport cases have been performed within the confines of the Burn, Medicine, and Cardiac ICUs, of which 9 were trauma patients. Indications for ECLS included respiratory failure (n=46; 79%), post cardiotomy (n=7, 12%), bridge to transplant (n=5, 8%), and cardiac failure (n=1, <1%). There has been a 73% survival rate to decannulation and a 62% survival rate to hospital discharge.
Conclusion: ECLS can provide demonstrable benefit for polytrauma patients suffering from respiratory failure or ARDS, and has potential applicability to military patients injured in theater. Our next step will be to review these cases to determine duration of cannulation and complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88666
Program Number: MSSP11
Presentation Session: Military iPoster (Non CME)
Presentation Type: MSSPoster