Extracorporeal membrane oxygenation in trauma patients with major pulmonary contusion

Patients with pulmonary contusion (PC) may require extracorporeal membrane oxygenation (ECMO) due to respiratory failure refractory to conventional management. We aimed to compare outcomes in patients with major PC who received ECMO with those who received conventional management.

We performed a retrospective cohort study using the Trauma Quality Improvement Program Database (2017-2020). We identified adult patients with major PC who underwent veno-arterial or veno-venous ECMO or had respiratory failure and received mechanical ventilation. The primary outcome was survival to discharge. Secondary outcomes included the rate of pulmonary embolism, stroke, and ventilator-associated pneumonia. We used 1:1 propensity matching to adjust for patient and injury characteristics. We used stepwise logistic regression to identify predictors of survival among PC patients undergoing ECMO.

We included 611 patients, of whom 106 (17%) underwent ECMO. Among 102 well-matched pairs, there was no difference in the rate of mortality (37% vs. 29%; p=0.23), pulmonary embolism (5% vs. 6%; p=0.76), or stroke (7% vs. 3%; p=0.19). The rate of ventilator-associated pneumonia was significantly lower in ECMO patients (14% vs. 36%; p<0.001). Among patients undergoing ECMO, 67 (63%) survived to discharge. In-hospital cardiac arrest, severe head injury, and age over 50 years were associated with lower survival, while anticoagulant use was associated with higher odds of survival.

ECMO is safe in trauma patients with major PC and may be associated with lower morbidity. Young patients without severe head injuries, cardiac arrest, and contraindications to anticoagulation may benefit most from ECMO. (J Trauma Acute Care Surg. 2026;00: 00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).

Therapeutic Study; Level IV.