T. D. Reid1, Y. Mikhaylov-Schrank1, C. Gaber1, P. D. Strassle1, R. Maine1, S. M. Higginson1, A. G. Charles1, C. Beckman1, B. A. Cairns1, L. Raff1 1University Of North Carolina At Chapel Hill,Chapel Hill, NC, USA
Introduction:
Burn inhalation patients are at risk for Acute Respiratory Distress Syndrome (ARDS) given pulmonary damage, systemic cytokine release, and large volume fluid resuscitation. As many as 86% of mechanically ventilated burn patients suffer from ARDS. Extracorporeal Membrane Oxygenation (ECMO) is a useful adjunct in patients with severe ARDS after failure of maximal ventilatory therapy. However, few studies have looked at the utility of ECMO following burn inhalation injury. We hypothesized that the use of ECMO in burn and inhalation injury patients is both safe and effective.
Methods:
This is a retrospective review of prospectively collected ECMO program data at the University of North Carolina. Patients included in the study were All adult and pediatric patients with burns and/or inhalation injury with ARDS that underwent Veno-venous (VV) or Veno-arterial (VA) ECMO cannulation between November 2008 and October 2017. Baseline characteristic information was collected. Primary outcomes included mortality on ECMO and 30-day mortality. Secondary outcomes included critical care and ECMO related complications. Frequencies and percentages were presented for categorical data and medians and interquartile ranges were presented for continuous data.
Results:
Of the 21 patients in this study, 16 (76%) were male. Six (29%) patients had burns only, 3 (14%) had inhalation injury only, and 12 (57%) had both burns and inhalation injury. Median percent burn was 28% of total body surface area. Patients had a median age of 48 years (IQR 26-55) with a range of 2 to 72 years. Median hours on ECMO was 116 hours and 90% percent of cannulations were VV. Substance abuse was common in this population at 33%. Eight (38%) patients required hemodialysis, which was performed via the ECMO circuit, and 12 (57%) patients were placed on a lasix infusion. Tracheostomy was performed in 18 (86%) patients. One (5%) patient died while on ECMO from cardiac causes. Total 30 day mortality was 19% (n=4) and 90-day mortality was 24% (n=5). These additional deaths were sepsis-related. Eight (38%) patients had ECMO-related complication; 3 (14%) had minor bleeding, 3 (14%) had bleeding requiring transfusion of more than 2 units, 1 (5%) had a deep venous thrombosis at the cannula site, 1(5%) had a malpositioned cannula, and 1(5%) had an arrhythmia. Only two of the patients who died had a complication related to ECMO. Both patients had bleeding requiring transfusion, however both patients died of sepsis unrelated to the bleeding.
Conclusion:
In this study, 30-day survival was 81%, and 90-day survival was 76%. While 38% of patients had complications, the majority were minor and did not lead to morbidity or mortality. These numbers are comparable to the current literature on ECMO unrelated to burns, that demonstrate a survival of approximately 60-75%. ECMO in burn and inhalation injury patients appears to be safe and effective. Larger trials are needed to examine the use of ECMO in this population.