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Published on: October 24, 2018
An epidemiological analysis of extracorporeal membrane oxygenation use in trauma
Marianne C Wallis1, Julie A Rizzo2, Erika R O'Neil2
1Department of Emergency Medicine, Department of Anesthesiology, Critical Care Section University of Colorado School of Medicine, 12401 E 17th Ave., Aurora, CO 80045, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) use in trauma care is increasing, with steady growth in facilities and stable survival rates. This study analyzes ECMO application and outcomes in adult and pediatric trauma patients.
Area of Science:
- Trauma Care
- Critical Care Medicine
- Cardiopulmonary Support
Background:
- Trauma is a leading cause of death in young adults and children.
- Severe polytrauma can lead to multi-organ failure, sometimes requiring extracorporeal membrane oxygenation (ECMO).
- ECMO use in trauma is rising, but practice patterns and outcomes data are limited.
Purpose of the Study:
- To conduct an epidemiological analysis of ECMO use in trauma patients.
- To describe current practice patterns and outcomes for ECMO in trauma.
- To analyze both adult and pediatric trauma populations requiring ECMO.
Main Methods:
- Analysis of the Trauma Quality Improvement Program Registry (2017-2023).
- Identification of ECMO application using procedure codes.
- Statistical analysis of all ECMO patients and a separate pediatric cohort (<18 years).
Main Results:
- 1919 out of 8,014,737 encounters involved ECMO; 224 were pediatric.
- Median time to ECMO initiation was 44 hours; annual incidence ranged from 1.9-2.9 per 10,000 encounters.
- Annual survival rates were 59%-68%; the number of ECMO-performing facilities increased.
Conclusions:
- ECMO use in trauma has shown consistent growth in performing facilities.
- Survival rates for ECMO in trauma are comparable to previous reports.
- Findings can inform clinical guidelines for ECMO in adult and pediatric trauma.
Background:
Trauma is the leading cause of death in younger adults and children. Severe polytrauma predisposes patients to the failure of multiple organ systems, including the cardiovascular and respiratory systems, at times necessitating extracorporeal membrane oxygenation (ECMO). ECMO use in the setting of trauma is increasing, yet little data exists describing current practice patterns. We performed an epidemiological analysis of ECMO use and outcomes in trauma patients.
Study Design And Methods:
We analyzed data from the Trauma Quality Improvement Program Registry from 2017 to 2023. Procedure codes were used to identify the application of ECMO. Pediatric patients were those < 18 years of age. We analyzed two groups from this data set: one including all patients who required ECMO and a separate group including only pediatric cases. We used descriptive and inferential statistical methods.
Results:
There were 8,014,737 encounters of which 1919 had documented ECMO use. Within that group, 224 were < 18 years of age. The median time from hospital arrival to the first initiation of ECMO was 44 h (interquartile range [IQR] 5-147). The incidence per year ranged from 1.9 to 2.9 events per 10,000 encounters. Survival ranged from 59% to 68% per year. The number of facilities with documented ECMO use annually ranged from 103 to 158 and overall increased during the time of the study. Interfacility transfer was common but was not related to survival.
Discussion:
ECMO use demonstrated steady growth in the number of performing facilities throughout the study period. Survival was similar to previous reports. Our findings will help inform targeted clinical guidelines for the use of ECMO in adult and pediatric trauma populations.
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