Traumatic Hemorrhagic Lung Injury With Pelvic and Femur Fractures Requiring Resuscitative Balloon Occlusion of the Aorta, Operative Fixation on Dual-Circuit Venous Extracorporeal Membrane Oxygenation, and Systemic Isoflurane Sedation

Abstract

Traumatic pulmonary hemorrhage is uncommon and rarely results in respiratory failure requiring mechanical circulatory support. Indications for extracorporeal membrane oxygenation (ECMO) in injured patients are not well-defined, but recent work indicates a potential survival benefit. Additionally, coughing-induced hemorrhage requires a complex sedation strategy. We describe management of a young polytrauma patient with traumatic lung failure requiring advanced venovenous (VV)-ECMO support and novel sedation strategy to facilitate healing. An 18-year-old boy sustained a 40-foot fall and developed widespread traumatic hemorrhagic pneumatoceles leading to respiratory arrest, ultimately requiring parallel-circuit VV-ECMO support, as well as systemic isoflurane sedation achieved through the ECMO circuit. Orthopedic fixation was performed while on VV-ECMO. This young polytrauma patient had a primary traumatic pulmonary hemorrhagic process and orthopedic traumatic injuries that were successfully managed with parallel-circuit VV-ECMO and isoflurane sedation through the circuit.

Keywords: extracorporeal membrane oxygenation; hemorrhage; injuries; isoflurane; lung injury; trauma.