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Case Reports
. 2019 May 6;14(1):88.
doi: 10.1186/s13019-019-0908-9.

A case report: Veno-venous extracorporeal membrane oxygenation for severe blunt thoracic trauma

Fumihiro Ogawa  1   2 , Takuma Sakai  3   4   5 , Ko Takahashi  4 , Makoto Kato  4 , Keishi Yamaguchi  3   4 , Sayo Okazaki  3   4 , Takeru Abe  3   4 , Masayuki Iwashita  3   4 , Ichiro Takeuchi  3   4   5
Affiliations
Case Reports

A case report: Veno-venous extracorporeal membrane oxygenation for severe blunt thoracic trauma

Fumihiro Ogawa et al. J Cardiothorac Surg. .

Abstract

Introduction: The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in trauma patients has been controversial, but VV-ECMO plays a crucial role when the lungs are extensively damaged and when conventional management has failed. VV-ECMO provides adequate tissue oxygenation and an opportunity for lung recovery. However, VV-ECMO remains contraindicated in patients with a risk of bleeding because of systemic anticoagulation during the treatment. The most important point is controlling the bleeding from severe trauma.

Case: A 32-year-old male experienced blunt trauma due to a traffic accident. He presented with bilateral hemopneumothorax and bilateral flail chest. We performed emergency thoracotomy for active bleeding and established circulatory stability. After surgery, the oxygenation deteriorated under mechanical ventilation, so we decided to establish VV-ECMO. However, bleeding from the bilateral lung contusions increased after VV-ECMO was established, and the patient was switched to heparin-free ECMO. After conversion, we could control the bronchial bleeding, especially the lung hematomas, and the oxygenation recovered. The patient was discharged without significant complications. VV-ECMO and mechanical ventilation were stopped on days 10 and 11, respectively. He was discharged from the ICU on day 15.

Conclusion: When we consider the use of ECMO for patients with uncontrollable, severe bleeding caused by blunt trauma, it may be necessary to use a higher flow setting for heparin-free ECMO than typically used for patients without trauma to prevent thrombosis.

Keywords: Blunt trauma; Hemopneumothorax; Veno-venous extracorporeal membrane oxygenation.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval for the study was given by the local ethics committee at Yokohama City University Center Hospital.

Consent for publication

Written consent was obtained from the patient for the publication of this case report and relevant images. A copy of the written consent is available for review by the Editor-in-chief of Journal of Cardiothoracic Surgery.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Chest X-ray images during the course of treatment: a initial; b postthoracotomy; c day 3 under full-heparin ECMO; d day 8 after heparin-free ECMO; e day 10 after removing ECMO; f day 15 after removing thoracic tubes
Fig. 2
Fig. 2
Chest CT images during the course of treatment: a initial; b postthoracotomy; c day 8 after heparin-free ECMO. Bleeding from bilateral lung contusions decreased before and after heparin-free ECMO
Fig. 3
Fig. 3
Bronchoscopy images during the course of treatment: a day 3 under full-heparin ECMO; b day 5 after heparin-free ECMO; c day 8 after heparin-free ECMO, with decreased bleeding from lung contusions
Fig. 4
Fig. 4
Graphs of metrics during the course of treatment: a ACT; b total bleeding from chest drainage tubes. Black bar: right chest drain. White bar: left chest drain. c D-dimer. We converted to heparin-free ECMO on day 5 (black arrowhead) and stopped ECMO on day 10 (white arrowhead)
See this image and copyright information in PMC

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