Transportable extracorporeal lung support for rescue of severe respiratory failure in combat casualties

Thomas Bein, David Zonies, Alois Philipp, Markus Zimmermann, Erik C. Osborn, Patrick F. Allan, Michael Nerlich, Bernhard M. Graf, Raymond Fang

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Advances in oxygenator membrane, vascular cannula, and centrifugal pump technologies led to the miniaturization of extracorporeal lung support (ECLS) and simplified its insertion and use. Support of combat injuries complicated by severe respiratory failure requires critical care resources not sustainable in the deployed environment. In response to this need, a unique international military-civilian partnership was forged to create a transportable ECLS capability to rescue combat casualties experiencing severe respiratory failure. METHODS: A multidisciplinary training and consultative relationship developed between the US military at Landstuhl Regional Medical Center (LRMC) and the University Hospital Regensburg (UHR), a German regional “lung failure†center with expertise in ECLS. ECLS circuits used were pumpless arteriovenous extracorporeal lung assist (NovaLung iLA) and pump-driven venovenous extracorporeal membrane oxygenation (PLS Quadrox D Membrane Oxygenator with Rotaflow Centrifugal Pump). US casualties supported by ECLS between June 2005 and August 2011 were identified from the LRMC Trauma Program Registry for review. RESULTS: UHR cared for 10 US casualties supported by ECLS. The initial five patients were cannulated with arteriovenous circuits (pumpless arteriovenous extracorporeal lung assist), and the remaining five were cannulated with pump-driven venovenous circuits (extracorporeal membrane oxygenation). Four patients were cannulated in the war zone, and six patients were cannulated at LRMC after evacuation to Germany. All patients were transferred to UHR for continued management (mean, 9.6 ECLS days). In all cases, both hypoxemia and hypercapnia improved, allowing for decreased airway pressures. Nine patients were weaned from ECLS and extubated. One soldier died from progressive multiple-organ failure. CONCLUSION: ECLS should be considered in the management of trauma complicated by severe respiratory failure. Modern ECLS technology allows these therapies to be transported for initiation outside of specialized centers even in austere settings. Close collaboration with established centers potentially allows both military and civilian hospitals with infrequent ECLS requirements to use it for initial patient stabilization before transfer for continued care. LEVEL OF EVIDENCE: Therapeutic/care management study, level V.

Original languageEnglish (US)
Pages (from-to)1450-1456
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume73
Issue number6
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

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Respiratory Insufficiency
Lung
Membrane Oxygenators
Extracorporeal Membrane Oxygenation
Technology
Miniaturization
Military Hospitals
Multiple Organ Failure
Hypercapnia
Trauma Centers
Military Personnel
Wounds and Injuries
Critical Care
Germany
Blood Vessels
Registries

Keywords

  • acute lung injury
  • adult respiratory distress syndrome
  • Extracorporeal membrane oxygenation
  • military medicine
  • transportation of patients

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Transportable extracorporeal lung support for rescue of severe respiratory failure in combat casualties. / Bein, Thomas; Zonies, David; Philipp, Alois; Zimmermann, Markus; Osborn, Erik C.; Allan, Patrick F.; Nerlich, Michael; Graf, Bernhard M.; Fang, Raymond.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 6, 01.12.2012, p. 1450-1456.

Research output: Contribution to journalArticle

Bein, T, Zonies, D, Philipp, A, Zimmermann, M, Osborn, EC, Allan, PF, Nerlich, M, Graf, BM & Fang, R 2012, 'Transportable extracorporeal lung support for rescue of severe respiratory failure in combat casualties', Journal of Trauma and Acute Care Surgery, vol. 73, no. 6, pp. 1450-1456. https://doi.org/10.1097/TA.0b013e3182782480
Bein, Thomas ; Zonies, David ; Philipp, Alois ; Zimmermann, Markus ; Osborn, Erik C. ; Allan, Patrick F. ; Nerlich, Michael ; Graf, Bernhard M. ; Fang, Raymond. / Transportable extracorporeal lung support for rescue of severe respiratory failure in combat casualties. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 6. pp. 1450-1456.
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abstract = "BACKGROUND: Advances in oxygenator membrane, vascular cannula, and centrifugal pump technologies led to the miniaturization of extracorporeal lung support (ECLS) and simplified its insertion and use. Support of combat injuries complicated by severe respiratory failure requires critical care resources not sustainable in the deployed environment. In response to this need, a unique international military-civilian partnership was forged to create a transportable ECLS capability to rescue combat casualties experiencing severe respiratory failure. METHODS: A multidisciplinary training and consultative relationship developed between the US military at Landstuhl Regional Medical Center (LRMC) and the University Hospital Regensburg (UHR), a German regional {\^a}€œlung failure{\^a}€ center with expertise in ECLS. ECLS circuits used were pumpless arteriovenous extracorporeal lung assist (NovaLung iLA) and pump-driven venovenous extracorporeal membrane oxygenation (PLS Quadrox D Membrane Oxygenator with Rotaflow Centrifugal Pump). US casualties supported by ECLS between June 2005 and August 2011 were identified from the LRMC Trauma Program Registry for review. RESULTS: UHR cared for 10 US casualties supported by ECLS. The initial five patients were cannulated with arteriovenous circuits (pumpless arteriovenous extracorporeal lung assist), and the remaining five were cannulated with pump-driven venovenous circuits (extracorporeal membrane oxygenation). Four patients were cannulated in the war zone, and six patients were cannulated at LRMC after evacuation to Germany. All patients were transferred to UHR for continued management (mean, 9.6 ECLS days). In all cases, both hypoxemia and hypercapnia improved, allowing for decreased airway pressures. Nine patients were weaned from ECLS and extubated. One soldier died from progressive multiple-organ failure. CONCLUSION: ECLS should be considered in the management of trauma complicated by severe respiratory failure. Modern ECLS technology allows these therapies to be transported for initiation outside of specialized centers even in austere settings. Close collaboration with established centers potentially allows both military and civilian hospitals with infrequent ECLS requirements to use it for initial patient stabilization before transfer for continued care. LEVEL OF EVIDENCE: Therapeutic/care management study, level V.",
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AU - Graf, Bernhard M.

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