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The use of ECMO in pediatric trauma resuscitation: A contemporary multicenter study
Mary E Moya-Mendez1, Victoria Donohue, Harold Leraas
1From the Division of Pediatric Surgery (M.E.M-M., H.L., D.B., E.T.T.), Duke Children's Hospital and Health Center, Durham, North Carolina; Department of Pediatrics (V.D.), Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric General and Thoracic Surgery (J.G., C.G.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pediatric Critical Care (T.W., T.H.), University Health Women's and Children's Hospital, University of Texas Health San Antonio, San Antonio, Texas; Division of Pediatric Critical Care (K.E.), Penn State Health Children's Hospital, Penn State College of Medicine, Hershey, Pennsylvania; Division of Pediatric Surgery (A.Y., H.M.P.), Washington University in St. Louis / St. Louis Children's Hospital, St. Louis, Missouri; Division of Critical Care Medicine, Department of Pediatrics (M.P.M., D.W.), University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas; Division of Pediatric Critical Care Medicine (S.R.B.), Oklahoma Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Division of Pediatric Critical Care Medicine (M.C.), Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa; Division of Critical Care, Department of Pediatrics (J.F-D.), Norton Children's Hospital, Louisville, Kentucky; Division of Pediatric Surgery (B.W.G., S.V.M.), Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana; Pediatric Intensive Care Unit (M.D.N.), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; and Division of Pediatric Surgery, Department of Surgery (C.O.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Insights
Extracorporeal membrane oxygenation (ECMO) offers comparable survival rates for pediatric trauma patients to non-traumatic cases. Early ECMO use in pediatric trauma, especially for airway injuries or drowning, shows promising survival benefits.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Surgery
- Cardiopulmonary Support
Background:
- Trauma is a leading cause of death in children.
- The efficacy of extracorporeal membrane oxygenation (ECMO) in pediatric trauma is not well-established.
- Understanding contemporary ECMO practices in pediatric trauma is crucial.
Purpose of the Study:
- To evaluate current ECMO practice patterns in pediatric trauma.
- To compare ECMO use in acute (<24 hours) versus subacute (≥24 hours) settings.
- To analyze outcomes based on trauma mechanisms and timing of ECMO initiation.
Main Methods:
- Multicenter retrospective study of children (0-20 years) receiving ECMO post-trauma.
- Data collected on trauma type, ECMO timing, complications, and survival.
- Analysis included a sub-cohort excluding drowning and foreign body aspiration (FBA).
Main Results:
- 55 children were included; overall survival was 69%.
- Survival rates varied significantly by trauma type, with FBA, cold-water drowning, and airway injuries showing 100% survival.
- While acute ECMO showed slightly lower survival (62% vs. 68%), this difference was not significant in the traumatic injury sub-cohort (p=0.53).
Conclusions:
- This study represents the largest multicenter analysis of pediatric trauma ECMO using contemporary data.
- Overall survival for pediatric trauma ECMO is comparable to non-traumatic ECMO cases.
- ECMO provides significant survival benefits for pediatric patients with FBA, cold-water drowning, and airway injuries.
Background:
Trauma remains the leading cause of death in all age groups of children, yet the role of extracorporeal membrane oxygenation (ECMO) in pediatric trauma remains unclear. The goal of this study was to evaluate contemporary ECMO practice patterns for pediatric trauma in both acute (<24 hours of trauma) and subacute (≥24 hours) settings.
Methods:
Multicenter, retrospective study of children aged 0-20 years cannulated to ECMO after a trauma (Total Study Population). Collected data included trauma mechanism, complications, and outcomes. A sub-cohort termed Traumatic Injury Population excluded patients cannulated after drowning or foreign body aspiration (FBA).
Results:
Eleven centers contributed data from 55 children (average age, 8.3 years; male, 53%) cannulated between 2006 and 2022. The most common trauma mechanisms were drowning (20%) and motor vehicle collision (MVC) (15%). The Total Study Population survival was 69% (38/55). Of children cannulated acutely, the most common trauma events were MVC (18%) and cold-water drowning (15%) while in children cannulated subacutely, they were burn (19%) and all-terrain vehicle accident (19%). Survival was significantly improved in the acute cohort compared with subacute cohort (62% vs. 68%, p = 0.04). In the Traumatic Injury Population, overall survival was 67% (28/42) with 63% of children cannulated acutely surviving compared with 69% of children cannulated subacutely ( p = 0.53). Children cannulated after FBA, cold-water drowning, and airway injury had 100% survival rate while those cannulated after penetrating thoracic or blunt abdominal injury, cardiac arrest, and cardiogenic shock had the worst survival (50%, 0%, 50%, 63%, respectively).
Conclusion:
This is the largest multicenter study to date using contemporary data of children who received ECMO for a trauma indication. Compared with national nontraumatic ECMO cannulations, our overall cohort, and sub-cohort of children with traumatic injuries, had comparable survival. Children cannulated after FBA, cold-water drowning, and airway injury benefitted the most from ECMO support.
Level Of Evidence:
Therapeutic/Care Management; Level IV.
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