Predictors of Survival in Patients With Severe Traumatic Brain Injury Undergoing Extracorporeal Membrane Oxygenation

The selection of patients for Extracorporeal Membrane Oxygenation (ECMO) needs to be optimized, especially in patients with severe traumatic brain injury (TBI). We aimed to identify predictors of survival in severe TBI patients. We also characterized trends of ECMO use in patients with severe TBI.

We retrospectively reviewed the Trauma Quality Improvement Program (TQIP) database for 2010-2020 and selected patients ≥18 years old with an Abbreviated Injury Score Head ≥3 who underwent ECMO. We excluded patients without signs of life on arrival or prehospital cardiac arrest, patients transferred out or discharged against medical advice, and patients with ECMO use >14 d after admission. Our primary outcome was predictors of survival to discharge using a stepwise regression analysis. Our secondary outcome was to analyze the trends in ECMO use among TBI patients.

We included 289 patients, of whom 164 (57%) survived to discharge. In the regression analysis, bilateral pulmonary laceration and in-hospital cardiac arrest were predictors of mortality, while age <50 years and anticoagulant use were protective. The proportion of patients with TBI undergoing ECMO gradually increased, with no significant change in mortality rates. An increasing proportion of ECMO cases were performed at community and nonteaching sites compared to academic sites during the study period.

ECMO is increasingly being utilized in trauma patients with TBI. Young patients without pulmonary laceration and absolute contraindications to anticoagulation may benefit most from ECMO.