Abstract
BackgroundUsing extracorporeal membrane oxygenation (ECMO) to provide advanced life support in adult trauma patients remains a controversial issue now. The study was aimed at identifying the independent predictors of hospital mortality in adult trauma patients receiving ECMO for advanced cardiopulmonary dysfunctions.MethodsThis retrospective study enrolled 36 adult trauma patients receiving ECMO due to advanced shock or respiratory failure in a level I trauma center between August 2006 and October 2014. Variables collected for analysis were demographics, serum biomarkers, characteristics of trauma, injury severity score (ISS), damage-control interventions, indications of ECMO, and associated complications. The outcomes were hospital mortality and hemorrhage on ECMO. The multivariate logistic regression method was used to identify the independent prognostic predictors for the outcomes.ResultsThe medians of age and ISS were 36 (27–49) years and 29 (19–45). Twenty-three patients received damage-control interventions before ECMO. Among the 36 trauma patients, 14 received ECMO due to shock and 22 for respiratory failure. The complications of ECMO are major hemorrhages (n = 12), acute renal failure requiring hemodialysis (n = 10), and major brain events (n = 7). There were 15 patients died in hospital, and 9 of them were in the shock group.ConclusionsThe severity of trauma and the type of cardiopulmonary dysfunction significantly affected the outcomes of ECMO used for sustaining patients with post-traumatic cardiopulmonary dysfunction. Hemorrhage on ECMO remained a concern while the device was required soon after trauma, although a heparin-minimized protocol was adopted.Trial registrationThis study reported a health care intervention on human participants and was retrospectively registered. The Chang Gung Medical Foundation Institutional Review Board approved the study (no. 201601610B0) on December 12, 2016. All of the data were extracted from December 14, 2016, to March 31, 2017.
Highlights
Using extracorporeal membrane oxygenation (ECMO) to provide advanced life support in adult trauma patients remains a controversial issue
The risk of hemorrhage on ECMO should increase while applying this heparin-equipped therapy to patients with a significant trauma-induced coagulopathy (TIC) [13, 14]
He was treated with mechanical ventilation (MV) and bilateral tube thoracostomies initially and prepared for VV-ECMO implantation later due to his clinical deterioration
Summary
Using extracorporeal membrane oxygenation (ECMO) to provide advanced life support in adult trauma patients remains a controversial issue now. The study was aimed at identifying the independent predictors of hospital mortality in adult trauma patients receiving ECMO for advanced cardiopulmonary dysfunctions. Instead of bypassing the lungs, venovenous (VV) ECMO returns the oxygenated blood back to the right atrium. According to the Extracorporeal Life Support Organization Registry International Report 2016 [12], the overall incidence of hemorrhage in ECMO-treated adult patients is around 34% (respiratory support) to 43% (cardiac support). The study was aimed at presenting our experience on ECMO used for post-traumatic cardiopulmonary dysfunctions and identifying the independent predictors of hospital mortality
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