ABSTRACT
BACKGROUND: The investigators present a series of adults with severe acute respiratory distress syndrome (ARDS) who were treated with extracorporeal membrane oxygenation (ECMO) at a regional referral center. METHODS: Patients with refractory hypoxic ARDS received ECMO until they recovered lung function or demonstrated futility. ECMO was initiated at the referring facility if necessary, and aggressive critical care was maintained throughout. RESULTS: ARDS due to multiple etiologies was managed with ECMO in 36 adults. The pre-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen was 48.3 ± 2.2. Regional facilities referred 89% of these patients, and 69% required ECMO for transport. The mean duration of ECMO was 7.1 ± .9 days for survivors, and the mean post-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen was 281.2 ± 11. ECMO was successfully weaned in 67% of patients, and 60% survived to discharge. CONCLUSIONS: ECMO provides support that prevents ventilator-induced lung injury while the lungs heal. The investigators present a series of 36 adults with refractory hypoxemic ARDS (ratio of partial pressure of oxygen to fraction of inspired oxygen <50) from 17 different facilities who, treated with ECMO at a single referral center, had a 60% survival rate.
Subject(s)
Extracorporeal Membrane Oxygenation , Respiratory Distress Syndrome/therapy , Tertiary Care Centers/organization & administration , Adolescent , Adult , Aged , Extracorporeal Membrane Oxygenation/instrumentation , Extracorporeal Membrane Oxygenation/methods , Female , Humans , Hypoxia/etiology , Hypoxia/therapy , Male , Middle Aged , Patient Transfer/statistics & numerical data , Referral and Consultation/statistics & numerical data , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/mortality , Retrospective Studies , Survival Rate , Transportation of Patients/methods , Transportation of Patients/organization & administration , Transportation of Patients/statistics & numerical data , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: The investigators compared a series of adult survivors of severe H1N1 pneumonia treated with extracorporeal membrane oxygenation (ECMO) with members of the Extracorporeal Life Support Organization registry for patients with H1N1 with regard to ventilator management while on ECMO. METHODS: Adults who survived ECMO were compared regarding time on ECMO for those treated with the Volume Diffusive Respirator (VDR) or with conventional "lung rest." The VDR delivered 500 percussions/min, with tidal pressures of 24/12 cm H2O and a fraction of inspired oxygen of .4 at 15 beats/min. RESULTS: There were no differences between the study patients (n = 7) and the Extracorporeal Life Support Organization cohort (n = 150) regarding age, pre-ECMO ventilator days, pre-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen, or survival after lung recovery. Patients treated with VDR required ECMO support for a shorter duration (mean, 193.29 ± 35.71 vs 296.63 ± 18.17 hours; P = .029). CONCLUSIONS: These data suggest that the VDR enhanced pulmonary recovery from severe H1N1 pneumonia in adults. Shorter times on ECMO may improve the risk/benefit and cost/benefit ratios associated with ECMO care.
Subject(s)
Extracorporeal Membrane Oxygenation , High-Frequency Ventilation/instrumentation , Influenza A Virus, H1N1 Subtype , Influenza, Human/therapy , Pneumonia, Viral/therapy , Ventilators, Mechanical , Adult , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Registries , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Survival of blunt trauma associated with hypothermic and hemorrhagic cardiac arrest in wilderness areas is extremely rare. CASE REPORT: We describe a case of a 19-year-old female college sophomore who, while glissading down Mt. Adams, had a 400-pound boulder strike her back and left pelvis, propelling her 40 feet down the mountain to land face down in the snow at 7000 feet. It took 4 h from the time of injury until the arrival of the helicopter at our Emergency Department and Trauma Center. The patient lost vital signs en route and had no CO(2) production. A cardiothoracic surgeon was the trauma surgeon on call. The patient was taken directly from the helipad to the operating room, where cutdowns enabled initial intravenous access, median sternotomy and pericardiotomy open heart massage, massive transfusion, chest and abdominal cavity irrigations with warm saline, correction of acid base imbalances and coagulopathies, and epicardial pacing that led to a successful reanimation of the patient. The patient was rewarmed without extracorporeal membrane oxygenation or heat exchangers. The ensuing multiple organ failures (heart, lungs, kidneys, intestines, brain, and immune system) and rhabdomyolysis led to a 2-month intensive care unit stay. She received over 120 units of blood and blood products. The patient regained cognitive function, mobility, and overcame multiple organ failure. CONCLUSION: This report is presented to increase awareness of the potential survivability in hypothermia, and to recognize the heroic efforts of the emergency services personnel whose efforts saved the patient's life.
