For severely burned patients with concomitant inhalation injury and acute respiratory distress syndrome, extracorporeal life support (ECLS) may improve sustained hypoxemia but had limited efficacy for hemodynamic support, according to findings from a single-center retrospective analysis published in Injury.
Investigators retrospectively reviewed their experience with ECLS with major burns at a military medical burn center from January 2012 to December 2019. They included patients with severe burns and concurrent inhalation injury and acute respiratory distress syndrome (ARDS) and having a poor response to maximal conventional ventilator therapy requiring ECLS intervention. A Kaplan-Meier curve was used to show survival condition by time.
There were 14 patients — 10 men and 4 women — included in the analysis. The median age was 42 (range, 19-59) years. The median burn total body surface area (TBSA) of deep dermal or full thickness (DD/FT) was 94.5% (range, 47%-99%). The median Baux score was 122 (range, 90-155). Venovenous ECLS (VV-ECLS) was used in 6 patients and venoarterial ECLS (VA-ECLS) was used in 8 patients, respectively, due to unstable hemodynamic status despite inotrope and vasopressor administration.
In all, 3 of the 6 VV-ECLS patients survived and 3 of the 8 VA-ECLS patients survived, respectively. The median interval from intubation to ECLS was 16.5 days in survivors and 1.5 days in nonsurvivors. The median ECLS duration was 4.6 days in survivors and 2.2 days in nonsurvivors. During ECLS, 8 patients had trunk escharotomies and 4 had limb fasciotomies to relieve compartment syndrome. ECLS-related complications included cannulation bleeding, catheter-related infection, and hemolysis.
Nonsurvivors had higher mean creatinine, glucose, lactate, and Baux score and lower mean albumin and lung compliance. Nonsurvivors had a higher incidence of Baux score greater than 120, albumin less than 3.0 g/dL, lactate greater than 8 mmol/L, median tidal volume of 350, and median lung compliance of 10, respectively.
The study was limited by the small study sample, yet this was the largest study so far of patients with such high Baux scores.
Given the survival to discharge rate of 42.8% in this cohort, the study authors concluded that “with adequate rigorous patient selection, ECLS could be a salvage modality therapy for patients with high Baux scores.”
Huang CH, Tsai CS, Tsai YT, et al. Extracorporeal life support for severely burned patients with concurrent inhalation injury and acute respiratory distress syndrome: experience from a military medical burn center. Injury. Published online September 7, 2022. doi:10.1016/j.injury.2022.08.063