Broadening indications: A descriptive and comparative in-depth analysis of venovenous extracorporeal membrane oxygenation outcomes in trauma and nontrauma patients

Holden Spivak; Appajosula Rao; Daniel Haase; Samuel Galvagno; Rishi Kundi; James O'Connor; Deborah Stein; Thomas Scalea; Elizabeth Powell

doi:10.1097/TA.0000000000004485

Broadening indications: A descriptive and comparative in-depth analysis of venovenous extracorporeal membrane oxygenation outcomes in trauma and nontrauma patients

J Trauma Acute Care Surg. 2024 Nov 18. doi: 10.1097/TA.0000000000004485. Online ahead of print.

Authors

Holden Spivak¹, Appajosula Rao, Daniel Haase, Samuel Galvagno, Rishi Kundi, James O'Connor, Deborah Stein, Thomas Scalea, Elizabeth Powell

Affiliation

¹ From the R Adams Cowley Shock Trauma Center (H.S., A.R., D.H., R.K., J.O., D.S., T.S., E.P.), University of Maryland Medical System; and Department of Anesthesiology (S.G.), University of Maryland School of Medicine, Baltimore, Maryland.

PMID: 39560952
DOI: 10.1097/TA.0000000000004485

Abstract

Background: Venovenous extracorporeal membrane oxygenation (VV ECMO) has been used for medical etiologies of acute respiratory distress syndrome refractory to conventional management. More recently, VV ECMO has been used to stabilize trauma patients with acute lung injury. We hypothesize that patients with traumatic injuries requiring VV ECMO have similar survival outcomes and describe the characteristics between the two populations.

Methods: This single-center, retrospective cohort study included all trauma and nontrauma patients in an 8-year period who were placed on VV ECMO. Cannulation decisions were made via multidisciplinary discussions between two intensivists and a trauma surgeon. Data were analyzed with descriptive statistics and regression analysis. After testing for normality, significance was defined as a p < 0.05.

Results: A total of 516 patients were identified (438 nontrauma and 78 trauma VV ECMO patients). The trauma patient, defined as undergoing cannulation during initial trauma admission, had a median age of 29 years with 81% of patients being male, while the nontrauma patient had a median age of 41 years with 64% being males. Trauma VV ECMO patients had shorter ECMO courses (216 hours vs. 372 hours, p < 0.001), earlier cannulation (8 hours vs. 120 hours, p < 0.001), higher lactic acid levels precannulation (4.2 mmol/L vs. 2.3 mmol/L, p < 0.001), higher Sequential Organ Failure Assessment scores (13 vs. 11, p = 0.001), and higher Simplified Acute Physiology Scores II (63 vs. 48, p < 0.001). There was no difference in bleeding complications. Survival to discharge rates were similar between trauma and nontrauma VV ECMO groups (69% vs. 71%, p = 0.81).

Conclusion: This study demonstrates that trauma VV ECMO patients have higher markers of severe illness/injury when compared with their nontrauma VV ECMO counterparts yet have similar survival rates and shorter ECMO runs. Venovenous extracorporeal membrane oxygenation in trauma patients is a useful treatment modality for refractory hypoxemia, respiratory acidosis, and stabilization because of acute lung and thoracic injury.

Level of evidence: Therapeutic/Care Management; Level IV.