Clinical outcomes of extracorporeal membrane oxygenation in acute traumatic lung injury: a retrospective study

Abstract

Background: Therapeutic extracorporeal membrane oxygenation (ECMO) is a challenging procedure in patients who have experienced severe trauma. Particularly, patients with traumatic lung injury and posttraumatic acute respiratory distress syndrome (ARDS) have a high risk of bleeding during this procedure. This study aimed to determine the safety and feasibility of ECMO in patients with traumatic ARDS.

Methods: We retrospectively reviewed medical records and investigated the clinical outcomes of ECMO in 42 patients with traumatic ARDS, among whom near-drowning (42.9%) was the most frequent cause of injury.

Results: Thirty-four of 42 patients (81%) survived and were discharged after a median hospital stay of 23 days. A multivariate analysis identified a lactate level (odds ratio: 1.493, 95% confidence interval: 1.060-2.103, P = 0.022) and veno-venous (VV) ECMO (odds ratio: 0.075, 95% confidence interval: 0.006-0.901, P = 0.041) as favorable independent predictors of survival in patients with traumatic ARDS who underwent ECMO. The optimal cut off value for pre-ECMO lactate level was 10.5 mmol/L (area under the curve = 0.929, P = 0.001). In Kaplan-Meier analysis, the survival rate at hospital discharge was significant higher among the patients with a pre-ECMO lactate level of 10.5 mmol/L or less compared with patients with pre-ECMO lactate level greater than 10.5 mmol/L (93.8% versus 40.0%, respectively; P = 0.01).

Conclusions: ECMO yielded excellent survival outcomes, particularly in patients with low pre-treatment lactate levels who received VV ECMO. Therefore, ECMO appears safe and highly feasible in a carefully selected population of trauma patients.

Keywords: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Trauma; Traumatic lung injury.

Fig. 1

Schematic of the principle of ECMO configurations. Abbreviations: ECMO, extracorporeal membrane oxygenation; P/F, partial arterial oxygen pressure to fractional inspired oxygen concentration; CPR, cardiopulmonary resuscitation; EF, ejection fraction; VV, venovenous; VA. venoarterial; V-AV, venoarteriovenous

Fig. 2

Receiver operating characteristic curve for predictability of pre-ECMO lactate level for survival to hospital discharge. The area under the receiver operating characteristic curve was 0.929 (95% confidence interval: 0.840 to 1.000, P = 0.001) for pre-ECMO lactate level. The optimal cut off value of pre-ECMO lactate level was 10.5 mmol/L for predicting survival at hospital discharge. In analysis of pre-ECMO lactate level 10.5 mmol/L, sensitivity of 85.7%, specificity of 86.7%, positive predictive value of 93.8%, and negative predictive value of 60.0% were noted. Abbreviation: ECMO, extracorporeal membrane oxygenation.

Fig. 3

Kaplan-Meier survival analysis based on lactate concentration. Kaplan–Meier survival curve for survival to hospital discharge between patients with pre-ECMO lactate level above 10.5 mmol/L(red line) and below 10.5 mol/L(blue line). The cumulative survival rate at hospital discharge was significantly higher for patients with a pre-ECMO lactate level of 10.5 mmol/L or less(blue line) compared with patients having a pre-ECMO lactate level greater than 10.5 mmol/L(red line, 93.8% versus 40.0%, respectively; P = 0.01)