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Extracorporeal life support in pediatric trauma: a systematic review
Thaddeus Puzio1,2, Patrick Murphy1, Josh Gazzetta1
1Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) shows promise for critically ill pediatric trauma patients, with a 60% survival rate in a limited study. Further research is needed to support its expanded use in this population.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Surgery
- Cardiopulmonary Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is increasingly used for adult trauma patients with ARDS and multisystem trauma.
- Evidence supporting ECMO use in pediatric trauma patients remains limited.
- This study addresses the paucity of data on pediatric trauma patients undergoing ECMO.
Approach:
- A comprehensive literature search was conducted using PubMed, MEDLINE, and Cochrane Database of Collected Reviews (1972-2018).
- Studies included pediatric patients (≤18 years) who received ECMO post-trauma and reported outcomes.
- Study quality was assessed using the Institute of Health Economics quality appraisal tool for case series.
Key Points:
- Four studies reported on 58 pediatric trauma patients (age <1-18 years) with overall poor study quality.
- Most patients (91%) received ECMO for acute respiratory distress syndrome (ARDS).
- Overall survival was 60%, with rates varying from 50% to 100%.
Conclusions:
- ECMO may be a viable therapeutic option for critically ill pediatric trauma patients.
- Consideration should be given to expanding ECMO utilization in pediatric trauma care.
- Pediatric patients at adult trauma centers with ECMO capabilities may benefit from this therapy.
Introduction:
Extracorporeal membrane oxygenation (ECMO) was once thought to be contraindicated in trauma patients, however ECMO is now used in adult patients with post-traumatic acute respiratory distress syndrome (ARDS) and multisystem trauma. Despite acceptance as a therapy for the severely injured adult, there is a paucity of evidence supporting ECMO use in pediatric trauma patients.
Methods:
An electronic literature search of PubMed, MEDLINE, and the Cochrane Database of Collected Reviews from 1972 to 2018 was performed. Included studies reported on ECMO use after trauma in patients ≤18 years of age and reported outcome data. The Institute of Health Economics quality appraisal tool for case series was used to assess study quality.
Results:
From 745 studies, four met inclusion criteria, reporting on 58 pediatric trauma patients. The age range was <1-18 years. Overall study quality was poor with only a single article of adequate quality. Twenty-nine percent of patients were cannulated at adult centers, the remaining at pediatric centers. Ninety-one percent were cannulated for ARDS and the remaining for cardiovascular collapse. Overall 60% of patients survived and the survival rate ranged from 50% to 100%. Seventy-seven percent underwent venoarterial cannulation and the remaining underwent veno-venous cannulation.
Conclusion:
ECMO may be a therapeutic option in critically ill pediatric trauma patients. Consideration should be made for the expansion of ECMO utilization in pediatric trauma patients including its application for pediatric patients at adult trauma centers with ECMO capabilities.
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