1887
2 - International Conference in Emergency Medicine and Public Health-Qatar Proceedings
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Use of ECMO has been shown to be an acceptable intervention for patients with respiratory failure refractory to optimal ventilator management. As experience with ECMO grows the indications for its use are also expanding.

Our patient is a 20-year-old female who was found lying on the roadside after being hit by a moving vehicle. She was rushed into the trauma room where she was intubated for low Glasgow coma scale, CT head, chest, abdomen and pelvis showed severe head injury with possible diffuse axonal injury, blunt chest injury, blunt abdominal injury with splenic injury was admitted under the care of TICU, repeat CT head showed multiple hemorrhagic contusions. Ventriculostomy with ICP monitoring device was inserted. She was aggressively treated for severe brain injury by neuroprotective interventions. Over following days had severe ARDS. Despite appropriate antibiotic therapy, lung protective ventilation, HFOV, patient had severe hypoxemia. Patient was evaluated for ECMO despite her severe neurological injury with ICH, possible poor neurological recovery. After discussions involving primary team, ECMO was considered initiated using femoral-Jugular cannulation. No systemic anticoagulation was used. Tracheostomy was placed and was weaned off ECMO over next week. ECMO decannulation was performed on 7th day. Patient had multiple interventions by the orthopaedic, weaned off decannulation in 18 days and tracheostomy was closed. Patient had neurological recovery was discharged to the rehabilitation.

ECMO is an established salvage therapy for profound respiratory failure and the need for systemic anticoagulation has often contraindicated its use in patients with severe intracranial pathology, and in particular, recent hemorrhage like our patient. Advances in circuit and oxygenator technology have challenged this concern and cases of ECMO support with intracranial pathology have been recently described. Risks and benefits of systemic anticoagulation need to be considered during ECMO support.

Extracorporeal membrane oxygenation is an acceptable therapy for patients with profound respiratory failure secondary to trauma and intracranial pathology contraindicating the use of systemic anticoagulation.

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/content/journals/10.5339/jemtac.2016.icepq.69
2016-10-09
2020-09-20
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  • Article Type: Research Article
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