EXTRACORPOREAL CARDIOPULMONARY LIFE-SUPPORT WITH HEPARIN-BONDED CIRCUITRY IN THE RESUSCITATION OF MASSIVELY INJURED TRAUMA PATIENTS

BACKGROUND: Patients who have massive but potentially survivable injur ies frequently die from complications of hypovolemia, hypoxemia, hypot hermia, metabolic acidosis, and coagulopathy. Emergency cardiopulmonar y bypass has been unsuccessful in preventing such deaths because it in volves systemic anticoagulation that exacerbates coagulopathy. PATIENT S AND METHODS: A simplified extracorporeal cardiopulmonary life suppor t (ECLS) system was assembled consisting of a centrifugal pump head, h eat exchanger, membranous oxygenator, percutaneous cannulas, and hepar in-bonded circuitry. The entire system has heparin-bonded surfaces. Pa tients were resuscitated with the system after femoral vein-femoral ar tery cannulation. ECLS was used to resuscitate massively injured patie nts who were deteriorating despite maximal conventional therapy. RESUL TS: While receiving maximal conventional therapy, 6 patients developed hypothermia, metabolic acidosis, and coagulopathy causing pulmonary h emorrhaging and hypoxemia from severe underlying lung injuries. ECLS w ith heparin-bonded circuitry provided cardiopulmonary support and rewa rming while physicians addressed coagulopathies and surgical bleeding and assessed survivability. Three patients survived. CONCLUSIONS: ECLS with heparin-bonded circuitry offers supplemental capability in the r esuscitation and cardiopulmonary support of selected massively injured patients while their primary injuries are being evaluated and treated .