Extracorporeal membrane oxygenation for acute respiratory distress syndrome in burn patients: a case series and literature update

Mehran Dadras; Johannes M Wagner; Christoph Wallner; Julika Huber; Dirk Buchwald; Justus Strauch; Kamran Harati; Nicolai Kapalschinski; Björn Behr; Marcus Lehnhardt

doi:10.1186/s41038-019-0166-z

Extracorporeal membrane oxygenation for acute respiratory distress syndrome in burn patients: a case series and literature update

Burns Trauma. 2019 Nov 1:7:28. doi: 10.1186/s41038-019-0166-z. eCollection 2019.

Affiliations

¹ 1Department of Plastic Surgery, BG University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany.
² 2Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany.

Abstract

Background: Acute respiratory distress syndrome (ARDS) has a reported incidence of 34-43% in ventilated burn patients and is associated with a mortality of 59% in the severe form. The use and experience with extracorporeal membrane oxygenation (ECMO) in burn patients developing ARDS are still limited. We present our results and discuss the significance of ECMO in treating burn patients.

Methods: A retrospective analysis of burn patients treated with ECMO for ARDS between January 2017 and January 2019 was performed. Demographic, clinical, and outcome data were collected and analyzed.

Results: Eight burn patients were treated at our institution with ECMO in the designated time period. Of these, all but one patient had inhalation injury, burn percentage of TBSA was 37 ± 23%, ABSI score was 8.4 ± 2, and R-Baux-score was 98 ± 21. Seven patients developed severe ARDS and one patient moderate ARDS according to the Berlin classification with a PaO₂/FiO₂ ratio upon initiation of ECMO therapy of 62 ± 22 mmHg. ECMO duration was 388 ± 283 h. Three patients died from severe sepsis while five patients survived to hospital discharge.

Conclusions: ECMO is a viable therapy option in burn patients developing severe ARDS and can contribute to survival rates similar to ECMO therapy in non-burn-associated severe ARDS. Consequently, patients with severe respiratory insufficiency with unsuccessful conventional treatment and suspected worsening should be transferred to burn units with the possibility of ECMO treatment to improve outcome.

Keywords: ARDS; Acute respiratory distress syndrome; Burns; ECMO; Extracorporeal membrane oxygenation; Inhalation injury.