(1720) An Assessment of Extracorporeal Membrane Oxygenation Practice Patterns and Outcomes in Trauma

Introduction: Major trauma often results in a dysregulated systemic response leading to multiorgan failure. Mechanical support may be applied as a bridge to recovery, including extracorporeal membrane oxygenation (ECMO). While ECMO use is well described for many indications, its use in trauma is poorly understood. We sought to determine the frequency of ECMO application, describe practice patterns and outcomes.

Methods: We analyzed data from the Trauma Quality Improvement Program (TQIP) datasets (2017-2022). De-identified facility key modules were used to determine locations reporting ECMO use. ECMO application was identified using procedural codes. Abbreviated injury scale scores were characterized as serious if ≥3. We present our findings using descriptive statistics with an exploratory multivariable logistic regression (MVLR) to assess factors associated with survival after application of ECMO via odds ratios (OR) and 95% confidence intervals (95% CI).

Results: There were 6,714,002 encounters including 1546 applications of ECMO (589 VV-ECMO, 282 VA-ECMO, 675 unspecified). ECMO use occurred in 276 facilities, of which 91% were Level 1 verified centers. The median time to initiation of ECMO was 53 hours (IQR 6-163). The median age was 30 (IQR 21-46, range 1-88) and 81% were male. The most common mechanisms of injury were collision (65%), firearms (15%), and falls (13%). The median composite injury severity score was 26 (IQR 17-38). Serious injury occurred to the head/neck (37%), thorax (76%), abdomen (32%), extremities (31%) and skin (7%). Kidney replacement therapy (KRT) was applied in 28%. Acute respiratory distress syndrome (ARDS) occurred in 31% and ventilator associated pneumonia in 6%. Survival to discharge was 65%. The following variables were associated with survival to discharge: serious injury to the head/neck (0.72, 0.57-0.92), serious injury to the skin (0.55, 0.36-0.83), KRT (0.46, 0.36-0.59), ARDS 1.52, 1.18-1.95), and VAP (1.80, 1.07-3.04).

Conclusions: ECMO use was infrequent, but survival was comparable to previous studies on ECMO use for other indications. ARDS and VAP were associated with a better prognosis, whereas serious injury to the head/neck and skin and KRT use were associated with worse outcomes. Better data is needed to understand the optimal applications of ECMO in trauma.