The Taipei Veterans General Hospital yesterday said it has for the first time successfully used extracorporeal membrane oxygenation (ECMO) to keep a critically injured patient alive without heparin.
The procedure — which uses a machine to take over the work of the lungs and sometimes the heart — was used to save the life of a 21-year-old man.
The man, a university student surnamed Lo (羅), was seriously injured when he came off his heavy motorcycle and suffered many internal injuries. He was transferred to the hospital’s emergency room from another hospital in November last year.
He was diagnosed with serious blunt trauma on both of his kidneys, alveolar hemorrhage, acute respiratory failure, nerve damage and arterial injuries, as well as many broken bones.
A surgeon who treated Lo, Wang Chien-ying (王鑑瀛), said that usually when ECMO is used on patients with major trauma, a blood thinner such as heparin is used to prevent blood clots from forming during and after surgery, and to reduce the risks of hear attack or stroke.
However, for patients with multiple trauma and massive bleeding such as Lo, heparin can inhibit hemostasis, the process which stops bleeding after an injury, he said, adding that his doctors were faced with a dilemma between “preventing blood clots” or “hemostasis.”
The trauma team led by Wang decided to not use heparin while applying ECMO, but transfused about 30 liters of blood over the course of the procedure, and Lo’s vital signs began to stabilize after two or three days.
Wang said that the ECMO equipment was removed after 12 days, and Lo was able to breathe unaided after 20 days.
According to WHO data, severe trauma is one of the major causes of death in young people.
Domestic statistics show that last year, accidental injury was the No. 1 cause of deaths in people aged from one to 24 and the No. 2 cause — after malignant tumors — of death in people aged from 25 to 44, the hospital said.
Wang said those who ride heavy motorcycles should wear helmets and other protective gear, pay more attention to traffic conditions especially at night or when visibility is poor, and remember to watch out for cars coming from the other direction when riding on mountainous or windy roads.
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