EXTRACORPOREAL LIFE-SUPPORT FOR PATIENTS WITH SIGNIFICANT ORTHOPEDIC TRAUMA

Extracorporeal life support is a therapeutic modality that can provide cardiorespiratory support for multiply injured patients. Fourteen pat ients with multiple trauma who sustained pelvic or long bone fractures were referred for treatment with extracorporeal life support at the U niversity of Michigan Medical Center. All patients were considered mor ibund secondary to their pulmonary injury. Six of the 14 patients had bilateral pulmonary contusions. The mean Injury Severity Score was 19. Twelve of the 14 patients had femoral or pelvic fractures or both. Ei ght patients had orthopaedic injuries initially treated with traction. The most common complication during extracorporeal life support manag ement was bleeding, which occurred in eight of 14 patients. Eight of t he 14 patients survived. Seven of eight patients with less than 6 days of mechanical ventilation before initiation of extra-corporeal life s upport survived. Only one of six patients with six or more days of mec hanical ventilation before initiation of extracorporeal life support s urvived. Patients with significant orthopaedic trauma and severe pulmo nary compromise have an extremely high mortality risk. Appropriate agg ressive fracture management remains the most important intervention to decrease the risk of pulmonary compromise. Early initiation of extrac orporeal life support can be an additional lifesaving intervention in select patients with orthopaedic trauma who have respiratory failure r efractory to conventional mechanical ventilation.