EXTRACORPOREAL LIFE-SUPPORT FOR RESPIRATORY-FAILURE AFTER MULTIPLE TRAUMA

Respiratory failure may complicate multiple trauma and can add signifi cant morbidity, mortality, and cost to the care of such patients. We u sed extracorporeal life support (ECLS) to treat 24 patients with multi ple trauma who, after their injury, developed respiratory failure refr actory to conventional ventilatory management. Injuries in these patie nts were the result of motor vehicle crashes (16 patients), pedestrian versus car collisions (3 patients), gunshots (2 patients), stabs (1 p atient), and a recreational vehicle crash (1 patient). Patients were p laced on venovenous or venoarterial ECLS, using continuous systemic an ticoagulation with heparin, and percutaneous cannulation where possibl e. Average time on ECLS was 287 +/- 43 hours (12 +/- 1.8 days). The ma jor complication was bleeding, which occurred in 75% of patients. Fift een patients survived to be discharged from the hospital (63% survival ). Early intervention (mechanical ventilation less-than-or-equal-to 5 days prior to ECLS) was associated with good outcome. Despite risks of anticoagulation in patients with multiple injuries, ECLS can be life- saving in cases of respiratory failure refractory to conventional mech anical ventilation.