Analysis of ECMO usage in trauma patients at a major level 1 trauma center

Abstract

Extracorporeal membrane oxygenation (ECMO) has been used for decades in patients where adequate oxygenation could not be achieved using traditional efforts. Data is emerging regarding its use in trauma. Retrospective data was collected from the ECMO database at an urban Level 1 trauma center between 2020 and 2024. Inclusion data was age > 17 years, trauma, and ECMO utilization during admission. Outcomes extracted included patient demographics, mechanism and type of injury, type of ECMO, ECMO days, hospital length of stay (LOS), intensive care LOS, date of injury to ECMO time, P/F ratio, ISS, complications, co-morbidities, anticoagulation, and mortality. Of the included 24 patients, 23 received veno-venous (VV) ECMO and one veno-arterial (VA) ECMO. The overall group demographics were: n = 23 males vs. n = 1 female, age 38.6 (±16.1) years. Duration of ECMO was 8.38 (±7.0) days, inpatient LOS 32.67 (±19.3) days, ICU LOS 26.33 (±18.0) days, DOI to initiation of ECMO 6.25 (±7.8). The ISS average was 29. The most common injury noted was rib fractures, average 4.6 (0−13) per patient. Other injuries included pneumothoraces (50 %), hemothoraces (35 %), blunt cardiac/sternal fracture (33 %). Complications on ECMO included transfusion requirement (54 %), DVT (13 %), and DIC (8 %). Of those studied, 87.5 % survived ECMO, with 70.8 % surviving to discharge. When using Mann-Whitney U and chi-square tests, there was not a statistically significant difference when comparing ISS, age, or P/F ratio between survivors versus non-survivors. Future research with increased sample size will be invaluable for the continued understanding of the role of ECMO in trauma.