Extracorporeal membrane oxygenation improves coagulopathy in an experimental traumatic hemorrhagic model

Purpose Hemorrhage is the most common cause of preventable death after trauma. Coagulopathy plays a central role in uncontrolled bleeding and is caused by multiple factors. Extracorporeal Membrane Oxygenation (ECMO) is an established treatment for patients with respiratory failure and has in recent...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2017-10, Vol.43 (5), p.701-709
Main Authors: Larsson, M., Forsman, P., Hedenqvist, P., Östlund, A., Hultman, J., Wikman, A., Riddez, L., Frenckner, B., Bottai, M., Wahlgren, C.-M.
Format: Article
Language:English
Subjects:
Acidosis
Anestesi och intensivvård
Anesthesiology and Intensive Care
Anticoagulants
Critical Care Medicine
Emergency Medicine
Extracorporeal membrane oxygenation
Intensive
Medicin och hälsovetenskap
Medicine
Medicine & Public Health
Original
Original Article
Ostomy
Respiratory failure
Respiratory therapy
Sports Medicine
Surgery
Surgical Orthopedics
Traumatic Surgery
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Summary:Purpose Hemorrhage is the most common cause of preventable death after trauma. Coagulopathy plays a central role in uncontrolled bleeding and is caused by multiple factors. Extracorporeal Membrane Oxygenation (ECMO) is an established treatment for patients with respiratory failure and has in recent years also been used in severely injured trauma patients with cardiopulmonary failure and coexisting bleeding shock. The aim of this study was to evaluate the effect of ECMO on hypothermia, acidosis, and coagulopathy in a traumatic hemorrhagic rabbit model. Methods After anesthesia and tracheostomy, ten New Zealand White rabbits sustained laparotomy, bilateral femur fractures and were hemorrhaged 45% of their estimated blood volume. After 90 min of hemorrhagic shock they were resuscitated with a standard transfusion protocol together with venoarterial ECMO ( n  = 5) or with a standard transfusion protocol only ( n  = 5) for 60 min. No systemic heparin was administered. Results ECMO during 60 min of resuscitation significantly increased heart rate ( p  = 0.01), mean arterial pressure ( p  = 0.01), body temperature ( p  = 0.01) and improved the metabolic acidosis, pH ( p  = 0.01), and lactate ( p  = 0.01). ECMO also improved the coagulation capacity measured in vitro by Rotational Thromboelastometry with a significant decrease in clot formation time ( p  
ISSN:1863-9933
1863-9941
1863-9941
DOI:10.1007/s00068-016-0730-1