THE STORY OF ONE PATIENT: MULTIPLE TRAUMA, ECMO, THE PATH TO LUNG TRANSPLANTATION AND ...

Abstract

The mortality rate for multiple trauma in combination with severe chest trauma according to Abbreviated Injury Scale (AIS) > 3 is very high: 15.1% for all ages and 28.4% for people 65 years and older [7].  Severe contusion of the lungs can lead to massive hemothorax and severe tracheobronchial bleeding.  If, for hemothorax, urgent surgery is performed based on chest drainage only, it is relatively difficult to find the source of tracheobronchial bleeding at an early stage of injury due to positive airway pressure ventilation.  Due to lung contusion, a huge amount of tissue factor is released, which worsens coagulopathy and leads to increased bleeding.  Worsening respiratory failure can also be caused by blood flow to the area of intact lungs from the area of the injured lungs.  The incidence of acute respiratory distress syndrome in trauma patients ranges from 4.3 to 8.5%.  In such cases, it is very difficult to maintain respiratory function only by standard ventilation control.  Over the past two decades, a number of treatments have been developed that have improved the survival rate of patients with ARDS.  Titration of lower tidal volumes and positive end-expiratory pressure (PEEP) significantly reduces mortality compared to traditional mechanical ventilation with high tidal volumes.  In recent years, neuromuscular blocks and prone positioning have been introduced, demonstrating the mortality benefits of ARDS. Other supportive therapies are used, such as inhalation of prostacyclin, as well as alternative ventilation modes, such as bi-level ventilation or reduced airway pressure ventilation (APRV).  Despite these advances in emergency therapies, some patients continue to deteriorate, and in such cases, veno-venous extracorporeal membrane oxygenation (IV-ECMO) becomes the best option as a last resort to save the lives of these patients.In this article, we presented a case of severe multiple trauma in a 35-year-old man with massive contusion of the lungs and continuing tracheobronchial bleeding, which led to the development of ARDS, destructive processes in the lungs and became the reason for the connection and long-term presence of the patient on VV-ECMO, due to the impossibility of providing with the help of mechanical ventilation gas exchange in the lungs.