W. Chen1, M. Zeeshan1, E. Zakaria1, N. Kulvatunyou1, T. O’Keeffe1, L. Gries1, A. Tang1, A. Northcutt1, B. Joseph1 1University Of Arizona,Trauma And Acute Care Surgery,Tucson, AZ, USA
Introduction:
Extracorporeal-membrane-oxygenation (ECMO) has been utilized in the neonatal respiratory distress syndrome. However, its role in trauma is evolving. The aim of our study was to evaluate the survival, trends of utilization and identify factors associated with mortality after ECMO in trauma patients over a 5-year period.
Methods:
We performed a 5-year (2008-2012) review of all trauma patients in the NTDB. We included all patients who underwent ECMO. Our primary outcome measures were trends of utilization and survival after ECMO in 5-year study period. Secondary outcome measures were in-hospital complications and factors associated with mortality after ECMO. Regression and trend analysis were performed.
Results:
Of the 808,211 trauma patients identified, 179 patients underwent ECMO. Mean age was 33y±15, 80% were male, and median ISS was 22[13-33]. Mechanism of injury (MOI) was blunt in 82%. Overall mortality was 34% (penetrating: 21% vs. blunt: 37%, p=0.03), and 31% (56/179) were discharged to SNF. The utilization of ECMO increased from 13.9 to 32.2 per 100,000 trauma admissions (p=0.01) while mortality rate decreased from 46.2% to 24% (p<0.001) during the study period (Figure 1). 47.5% of patients who received ECMO had ARDS, 45.7% had pneumonia, 32.1% had cardiac arrest, 22.8% developed AKI and 14.8% developed sepsis. On regression analysis, increasing age (OR: 1.12[1.03-1.25]) and ISS (OR 1.17[1.03-1.26]) were independently associated with mortality while centers that were performing multiple ECMO were associated with improved mortality (OR: 0.55[0.12-0.82]).
Conclusion:
Two thirds of patients who undergoes ECMO survived. The use of ECMO in trauma patients has increased while the mortality rate has declined. Patients who undergo ECMO in trauma centers that frequently perform ECMO tend to do better. Further studies are required to better define the role of ECMO in trauma and identify the subset of population that may benefit from this procedure.
