Timing of Extracorporeal Membrane Oxygenation and Outcomes in Adult Patients With Moderate-Severe Blunt Thoracic Trauma.

IF 0.9 4区医学 Q4 CRITICAL CARE MEDICINE

Journal of Trauma Nursing Pub Date : 2025-09-29 DOI:10.1097/JTN.0000000000000885

Philip Lee, Nikita Nunes, Andrew Ford, Ruth Zagales, Zackary Yates, Kirk Dourvetakis, Nickolas Hernandez, Chadwick P Smith, Adel Elkbuli

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引用次数: 0

Abstract

Background: There is mixed evidence on the optimal timing of veno-venous extracorporeal membrane oxygenation (VV-ECMO) following significant trauma.

Objective: This study aims to assess the timing of VV-ECMO initiation and its effect on clinical outcomes in adult patients with moderate-severe blunt thoracic trauma.

Methods: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) database between 2015 and 2023 to evaluate the clinical effects of VV-ECMO in adult patients (≥18 years) with blunt, moderate-severe thoracic and thoraco-abdominal trauma. Outcomes of interest included in-hospital mortality, intensive care unit length of stay (ICU-LOS), complications such as deep vein thrombosis, pulmonary embolism, acute kidney injury, and discharge disposition.

Results: There were 412 adult patients with moderate-severe blunt thoracic and thoraco-abdominal trauma who received VV-ECMO, of which 256 (61.8%) were initiated within ≤7 days and 105 (25.4%) after 7 days. Patients with VV-ECMO initiation within ≤7 days had no difference in mortality rates (adjusted odds ratio [aOR] .655, p = .246) but had five fewer ICU-LOS days (β: -5.364, p = .002). Additionally, patients receiving early VV-ECMO were less likely to be discharged home (aOR: .192, p = .017) than all other discharge dispositions. No differences were observed in transfusion needs or complication rates.

Conclusion: Initiation of VV-ECMO within ≤7 days was associated with significantly shorter ICU-LOS and comparable odds of mortality, without significant differences in complications or adverse events, including transfusion requirements and venous thromboembolism. Trauma and critical care societies should consider these findings when revisiting existing ECMO protocols concerning the early initiation of VV-ECMO to improve outcomes in this population.

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成人中重度钝性胸外伤患者体外膜氧合时机与预后。

背景：关于重大创伤后静脉-静脉体外膜氧合（VV-ECMO）的最佳时机，证据不一。目的：本研究旨在评估VV-ECMO启动时机及其对成人中重度钝性胸外伤患者临床预后的影响。方法：本回顾性队列研究利用2015 - 2023年美国外科医师学会创伤质量改善计划参与者使用档案（ACS-TQIP-PUF）数据库，评估VV-ECMO在成人（≥18岁）钝性、中重度胸腹外伤患者中的临床效果。研究结果包括住院死亡率、重症监护病房住院时间（ICU-LOS）、深静脉血栓形成、肺栓塞、急性肾损伤等并发症和出院处置。结果：412例成人中重度钝性胸、胸腹外伤患者行VV-ECMO，其中≤7天内启动的256例（61.8%），7天后启动的105例（25.4%）。在≤7天内开始VV-ECMO的患者死亡率无差异（校正优势比[aOR]）。655, p = .246)，但ICU-LOS天数减少5天（β: -5.364, p = .002）。此外，早期接受VV-ECMO的患者出院回家的可能性较小。192, p = .017)。在输血需求和并发症发生率方面没有观察到差异。结论：在≤7天内开始VV-ECMO与较短的ICU-LOS和相当的死亡率相关，并发症或不良事件（包括输血要求和静脉血栓栓塞）无显著差异。创伤和重症监护学会在重新审视现有的早期VV-ECMO方案时应考虑这些发现，以改善这一人群的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma Nursing CRITICAL CARE MEDICINENURSING&-NURSING

CiteScore

1.20

自引率

10.00%

发文量

106

期刊介绍： Journal of Trauma Nursing (JTN) is the official journal of the Society of Trauma Nurses. The Society of Trauma Nurses believes that trauma is a disease impacting patients through the continuum of care. The mission of STN is to ensure optimal trauma care through education, collaboration, leadership and membership engagement. As the official publication of the Society of Trauma Nurses, the Journal of Trauma Nursing supports the STN’s strategic goals of effective communication, education and patient advocacy with original, peer-reviewed, research and evidence-based articles and information that reflect the highest standard of collaborative care for trauma patients. The Journal of Trauma Nursing, through a commitment to editorial excellence, implements STN’s vision to improve practice and patient outcomes and to become the premiere global nursing organization across the trauma continuum.