National Estimates of the Use and Outcomes of Extracorporeal Membrane Oxygenation After Acute Traumatic Injury

Objective: The use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe Acute Respiratory Distress Syndrome (ARDS) is gaining greater acceptance among trauma intensivists. National... [ view full abstract ]

Objective: The use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe Acute Respiratory Distress Syndrome (ARDS) is gaining greater acceptance among trauma intensivists. National estimates of ECMO use as a viable treatment in post-traumatic severe ARDS have not been reported. The objective of this study was to review ECMO usage in trauma patients in the United States.  

Methods: The Nationwide Inpatient Sample (NIS) from years 2002 to 2012 was queried for patients aged 15 and older treated with ECMO who had one or more acute traumatic injuries as defined by International Diagnostic Codes, ninth edition (ICD-9). Primary outcomes of interest were incidence of ECMO and overall inpatient mortality.

Results: A total of 1,347 patients were identified in the NIS database that had both ECMO performed and ICD-9 codes consistent with trauma. Patients were predominantly age 15-29 years (31.4%) and male (65.5%). The incidence of ECMO for patients after traumatic injuries has increased 66 fold over the 10-year period. In hospital mortality was 48.0% overall, with a decreasing trend over the study period that approached statistical significance (p=0.06).

Conclusions: While ECMO use in patients with severe ARDS in the post-trauma setting remains controversial, there is an increasing trend to utilize ECMO nationwide, suggesting an increasing acceptance and/or increased availability at trauma centers. Given the decrease in mortality over the study period, ECMO as a salvage method in trauma patients with refractory ARDS remains a potentially viable option. Evaluation in a prospective manner may clarify risks and benefits.