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

• Main Authors: Hong Kyu Lee, Hyoung Soo Kim, Sang Ook Ha, Sunghoon Park, Hee Sung Lee, Soo Kyung Lee, Sun Hee Lee
• Format: Article
• Language: English
• Published: BMC 2020-05-01
• Series: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
• Subjects: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Trauma; Traumatic lung injury
• Online Access: http://link.springer.com/article/10.1186/s13049-020-00733-w

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.