Extra-Corporeal Membrane Oxygenation (ECMO) following traumatic injury.

BACKGROUND: The use of ECMO for acute respiratory failure following injury is controversial and poorly described.

METHODS: We reviewed our single-center experience with use of ECMO from January 2006 to November 2015 at a Level 1 primary adult resource center for trauma to determine the association of in-hospital mortality with patient demographics and clinical variables.

RESULTS: 46 patients were treated with ECMO. Patients requiring venoarterial ECMO (n=7) were excluded. Thirty-nine (85%) were cannulated for venovenous ECMO. Of these, (44%) patients survived to discharge. Median age was 28 years. Survivors had a lower BMI and PaCO2 at time of cannulation. Non-survivors were more severely injured (median ISS 41 vs. 25, p=0.03), had a lower arterial pH on arrival, and a shorter length of stay (11 vs. 41 days, p=0.006). Neither mechanism of injury nor indication for ECMO were associated with mortality. 41% developed at least one ECMO-related complication, but this was not associated with mortality. 94% of survivors were anticoagulated with heparin vs. 55% of non-survivors (p=0.01). Median ISS and presence of TBI were not significantly different between survivors and non-survivors who were anticoagulated.

CONCLUSIONS: The use of venovenous ECMO for acute lung injury following trauma should be considered in special patient populations. Ability to tolerate systemic anticoagulation was associated with improved survival.

LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.