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Extracorporeal Membrane Oxygenation Use in Pediatric Trauma: A Report From the National Trauma Data Bank
Mahmoud G El Baassiri1, Eric Etchill1, Charbel Chidiac1
1Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) use in pediatric trauma increased, with higher injury severity scores and specific injuries like burns or intracranial hemorrhage linked to increased mortality. ECMO remains a potentially vital intervention for critically injured children.
Area of Science:
- Pediatric Trauma Care
- Extracorporeal Membrane Oxygenation (ECMO)
- Critical Care Medicine
Background:
- Indications for pediatric extracorporeal membrane oxygenation (ECMO) in trauma are evolving.
- This study examines trends and outcomes of ECMO use in injured children.
- Utilizes the National Trauma Data Bank (NTDB) for comprehensive data analysis.
Purpose of the Study:
- Evaluate current trends in ECMO application for pediatric trauma patients.
- Identify factors associated with in-hospital mortality in this population.
- Assess secondary outcomes including length of stay and complications.
Main Methods:
- Retrospective review of pediatric trauma patients (≤18 years) who received ECMO.
- Data sourced from the National Trauma Data Bank (NTDB) spanning 2007-2018.
- Multivariable regression analysis to determine predictors of mortality.
Main Results:
- ECMO use significantly increased from 2013-2018 (79.2%).
- Overall in-hospital mortality was 37.3%, with higher Injury Severity Scores (ISS) and burn injuries as significant risk factors.
- Cardiac arrest, unspecified intracranial hemorrhage (ICH), and intentional injuries also correlated with increased mortality.
Conclusions:
- This study represents the largest analysis of pediatric trauma ECMO use.
- Factors like ISS, cardiac arrest, burns, and ICH significantly impact mortality post-ECMO.
- Growing ECMO utilization suggests its potential efficacy in managing severe pediatric trauma.
Introduction:
Indications for extracorporeal membrane oxygenation (ECMO) in pediatric trauma continue to evolve. This study evaluates trends and practices in ECMO use for injured children and identifies factors associated with mortality using the National Trauma Data Bank (NTDB).
Methods:
We conducted a retrospective review of children ≤18 years who underwent ECMO therapy following trauma, recorded in the NTDB from 2007 to 2018. The primary outcome was in-hospital mortality. Secondary outcomes were hospital length of stay (LOS) and in-hospital complications. Multivariable regression models identified factors associated with mortality.
Results:
Out of 217 children cannulated onto ECMO from 2007 to 2018, 172 (79.2 %) were from 2013 to 2018. Median age was 16 years (IQR 9-17) and 158 (72.8 %) patients were male. The median injury severity score was 26 (IQR 18-38). The thorax (71.9 %) and extremities (63.6 %) were the most common sites injured. Overall, in-hospital mortality was 37.3 %. Median ICU LOS among survivors was 16 days (IQR 5-32). Common complications included acute respiratory failure (29 %), cardiac arrest (24 %) and acute renal failure (17.5 %). On multivariable analysis, higher ISS (adjusted OR [aOR] 1.04, 95%CI 1.01-1.07), the presence of burn injuries (aOR 4.35, 95%CI 1.01-18.74), ICH of unspecified type at presentation (aOR 4.22, 95%CI 1.21-14.68), and intentional injury (aOR 12.7, 95%CI 2.77-58.26) were associated with increased mortality.
Conclusion:
This is the largest contemporaneous study of ECMO use in injured children. Many factors such as ISS, cardiac arrest, presence of burn injuries and unspecified ICH increase the rate of in-hospital mortality following ECMO utilization post-trauma. The increase in ECMO utilization over the years support its role as a potentially effective intervention for pediatric trauma patients.
Study Type:
Original Article (Retrospective study, level of evidence III).
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