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Abstract

Background and aims: Recent years saw an increase in single center reports on the use of extracorporeal membrane oxygenation (ECMO) in trauma patients, defying traditional contraindications for ECMO. Aims: This study aims to investigate patterns of ECMO use in trauma using a large national USA database. Methods: We queried the National Trauma Data Bank (NTDB) for the use of ECMO (ICD9 code 39.65). Group comparisons were done by ECMO use and age. The institutional review board reviewed and exempted research from the NTDB. Results: We identified 154 patients who presented to 68/838 trauma centers reporting to the NTDB between 2007–2011 and who underwent ECMO. Age was significantly younger compared to patients who did not undergo ECMO (median 24y, interquartile range [IQR], 19y-36y vs 39y, IQR: 21y-60y, p<0.001), 124 (80.5%) were male and 86 (58%) were white. The Injury Severity Score (ISS) was significantly higher in patients who required ECMO vs patients who didn’t: median 25, IQR: 16–34 vs 9 (IQR: 4–13), p<0.001. Eighty-four (59%) patients were admitted directly to an intensive care unit, and 44 (31%) required initial surgical stabilization. A quarter of the patients had severe head injury. Sixty-six (43%) patients had acute respiratory distress syndrome (ARDS) (57% survival, p=0.68), and 33 (22%) suffered cardiac arrest (CA) (29% survival, p=0.001). Overall survival was 55%. Compared to adults, children had similar ISS, rates of severe head injury, ARDS, CA, and survival (p>0.05 for all). Conclusions: This is the largest dataset detailing outcomes of trauma patients requiring ECMO. Survival is comparable to other ECMO patient populations. Outcomes in children are similar to adults.