Extracorporeal membrane oxygenation in trauma: a single-center retrospective observational study

Globally, trauma is a leading cause of death in young adults. The use of extracorporeal membrane oxygenation (ECMO) in the trauma population remains controversial due to the limited published research. This study aimed to analyze 30-day survival of all the trauma ECMO patients at our center, with respect to injury severity score (ISS) and new injury severity score (NISS).

We performed a retrospective analysis of all trauma patients receiving ECMO support at a Level 1 trauma center in Sweden between 1997 and 2019.

A total of 53 trauma patients received ECMO support. 85% were male; the median age was 24, with interquartile range (IQR) 17-44 years. More than 70% were multi-trauma patients. The mean NISS and ISS were 50 (IQR:34-57) and 42 (IQR:33-57), respectively. 62% were supported on veno-arterial ECMO with a survival benefit for veno-venous ECMO (75% vs. 36%, respectively (p = 0.01)). There was no association between severity in terms of trauma-score and survival. Sixteen patients (30%) were cannulated at referring hospitals and transported to our unit on ECMO with a survival of 69%, similar to those cannulated in-house. 60% of patients survived ECMO, and 51% survived to hospital discharge.

This study indicates that trauma patients may benefit from ECMO, independent of severity. Furthermore, our results support ECMO transport as feasible in trauma patients. We recommend larger multi-center studies to determine which trauma patients would have the greatest benefit of ECMO.