Extracorporeal membrane oxygenation in trauma patient in France: A retrospective nationwide registry

Abstract

Background: Indications for Veno-venous (VV) or veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) after trauma rely on poor evidence. The main aims were to describe the population of trauma patients requiring either VV or VA ECMO and report their clinical management and outcomes.

Methods: An observational multicentre retrospective study was conducted in 17 Level 1 trauma centres in France between January 2010 and December 2021. All patients admitted for major trauma were screened for inclusion, and those receiving either VV ECMO or VA ECMO were included. The primary outcome was in-hospital mortality.

Results: Among the 52,851 patients screened, 179 were included, with 143 supported by VV ECMO (median [Q1-Q3] age 32 years [24-48]; men 83.5%; injury severity score [ISS] 33 [25-43] and 76 (53.6%) with a traumatic brain injury [TBI]) and 36 supported by VA ECMO (median age 39 years [25-55]; men 88.9%; ISS 36 [25-56] and 23 (63.9%) with a TBI). In the VV ECMO group, three indications for ECMO implementation were chest injuries (n = 68, 47.6%), ventilator-associated pneumonia (VAP; n = 57, 39.9%), and extra-respiratory acute respiratory distress syndrome (ARDS; n = 57, 39.9%). In the VV ECMO group, 45.8% (n = 65) died in the hospital, with 33 (48.5%) deaths following cannulation for chest injuries, 22 (39.3%) following cannulation for VAP, and 10 (55.6%) following cannulation for extrapulmonary ARDS. In the VA ECMO group, 75.0% (n = 27) died during their hospital stay.

Conclusions: In-hospital mortality of trauma patients requiring ECMO for refractory ARDS varied according to indications. The best prognosis was observed in the subgroup of pneumonia-induced ARDS patients.

Keywords: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Multiple trauma.