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

https://doi.org/10.1016/S0002-9610(99)80201-3Get rights and content

Background

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.

Patients and methods

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.

Results

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.

Conclusions

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.

References (14)

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    A heat exchanger device is integrated into the ECLS circuit to restore and maintain the patient's temperature. These features are particularly important in polytraumatized patients [4,7–11,13,16,17,19]. In polytraumatized patients, due to actual or potential bleeding risk we [11], as other authors [4,18,19] initially perform heparin-free extracorporeal support until bleeding has stopped and normalization of patient coagulative status is achieved.

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*

Presented at the 81st Annual Meeting of the North Pacific Surgical Association, Coeur d'Alene, Idaho, November 10–11, 1994.

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