ECMO for ARDS in pediatric and adult trauma patients?
Yes – even with CHI (Closed Head Injury) !
ECMO is being used in these patients with great results. As we are all aware, ARDS is a known complication in trauma patients due to both injury and the results of aggressive resuscitation efforts. Even with attentive measures including gentle ventilation (such as low TV) and close monitoring of amounts and types of fluids given, patients frequently develop ARDS. Speakers presented cases of initiating ECMO on these patients, generally at least 48 hours following initial injury. Close attention is paid to bleeding and fibrinolysis. It was suggested to reduce heparin doses managed by maintaining anti Xa goal of 0.1-0.2 and being proactive with the use of Amicar both as a bolus prior to cannulation and a drip for the first 24-48 hours.For management of these patients, the main focus is Rest and Patience. Decrease patient vent settings to rest settings once ECMO flow is achieved.
Be patient with these patients. We, as medical professionals, feel we need to be actively providing treatment for patients that are this ill but we have to remember WE ARE! We have them on ECMO!
And last but not least, no recruitment measures. These measures are causing more damage to already damaged and inflamed lungs.
Other treatments being preformed are daily bronchoscopy for wash outs and evaluation, decreased sedation to allow for accurate neuro exams as well as monitor for seizures and alertness. Head CT is performed after 48 hours for evaluation of new or old bleeding.
Many centers are having great outcomes on pediatric and adult trauma patients with ARDS.
As reported by Amanda Smith RN, ECMO Advantage Specialist