Extracorporeal Life Support Use in Adult Burn Patients

Burn-related cardiopulmonary failure causes significant morbidity and is associated with increased risk of death. Extracorporeal life support (ECLS) may be used to support burn patients, but its efficacy and safety in this population have not been well defined. This study examined survival rates and risk factors for death in adult burn patients who received ECLS. Retrospective data from the Extracorporeal Life Support Organization international registry were analyzed to determine clinical outcomes and risk factors for death in adult burn patients treated with ECLS. During the study period, we identified 58 adult burn patients who were treated with ECLS. Overall survival to hospital discharge was 43%. Survivors and nonsurvivors were similar in age, gender, body weight, mode of ECLS used, and duration of ECLS. Nonsurvivors had lower pH values (7.15 vs 7.30, P < .001) and higher pCO2 values (65.5 vs 50.5, P = .038) before initiation of ECLS. Nonsurvivors had higher rates of renal failure (49 vs 16%, P = .01) and renal replacement therapy (70 vs 36%, P = .016). Infection was documented in 21 patients; survival in this group was 43%. Multivariate logistic regression analysis identified acidosis (pH < 7.16) and the use of inotropic/vasopressor medications before ECLS as risk factors associated with increased risk of mortality. ECLS appears to be a viable treatment option for adult burn patients with cardiopulmonary failure. ECLS survival in adult burn victims is similar to that observed in nonburn patient populations treated with ECLS.