K. Carlson1, N. K. Dhillon1, G. Liao1, C. Colovos1, R. Chung1, D. R. Margulies1, E. J. Ley1, G. Barmparas1 1Cedars-Sinai Medical Center,Los Angeles, CA, USA
Introduction: Traditional metrics to evaluate quality of care among trauma centers are inconsistent. Evaluating access to additional resources might offer more useful metrics. We aimed to characterize outcomes of trauma patients undergoing extracorporeal membrane oxygenation (ECMO) and to assess whether trauma centers with ECMO capabilities have improved overall survival.
Methods: Patients receiving ECMO therapy at Level I and II centers from 2007 to 2011 were selected from the National Trauma Data Bank. A logistic regression was utilized to calculate the adjusted odds ratio (AOR) for mortality between patients admitted to centers with ECMO capabilities to those admitted to centers with no such capabilities.
Results: A total of 97 patients admitted to 37 centers were included. The median age was 25 years and 76% were male. Injury severity score was high (median 25). Initiation of ECMO ranged from day 0 to 90 from admission. ARDS was present in 52%. Overall mortality was 43%. The 37 centers with ECMO capabilities were mostly Level I (94%), and academic (90%). Compared to patients admitted to Level I and II centers with no ECMO capabilities, those admitted to centers with ECMO capabilities had a significantly lower overall mortality (AOR: 0.86, p<0.01).
Conclusion: Although the number of trauma patients who require ECMO is small, admission to trauma centers with access to ECMO is associated with improved survival. This survival advantage may reflet the availability of advanced therapies for critically ill trauma patients. Access to ECMO could be considered one of the quality metrics for trauma centers.