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Frequency of extracorporeal membrane oxygenation utilization among trauma centers during the study period
Source publication
Background:
Access to centers with extracorporeal membrane oxygenation (ECMO) capabilities varies by region and may affect overall outcomes. We assessed the outcomes of trauma patients requiring ECMO support and compared the overall survival of all patients with trauma at facilities with and without ECMO capabilities.
Methods:
A retrospective re...
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Background
The identification of risk factors for severe injury is crucial in trauma triage and trauma team activation (TTA) depends on a sufficient triage. The aim of this study was to determine whether or not elevated serum lactate levels and age are risk factors for severe injury in TTA due to trauma mechanism.Methods
We conducted a retrospectiv...
Citations
Background
Severe trauma can result in cardiorespiratory failure, and when conventional treatment is ineffective, extracorporeal membrane oxygenation (ECMO) can serve as an adjunctive therapy. However, the indications for ECMO in trauma cases are uncertain and clinical outcomes are variable. This study sought to describe the prognosis of adult trauma patients requiring ECMO, aiming to inform clinical decision-making and future research.
Methods
A comprehensive search was conducted on Pubmed, Embase, Cochrane, and Scopus databases until March 13, 2023, encompassing relevant studies involving over 5 trauma patients (aged ≥ 16 years) requiring ECMO support. The primary outcome measure was survival until discharge, with secondary measures including length of stay in the ICU and hospital, ECMO duration, and complications during ECMO. Random-effects meta-analyses were conducted to analyze these outcomes. The study quality was assessed using the Joanna Briggs Institute checklist, while the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.
Results
The meta-analysis comprised 36 observational studies encompassing 1822 patients. The pooled survival rate was 65.9% (95% CI 61.3–70.5%). Specifically, studies focusing on traumatic brain injury (TBI) (16 studies, 383 patients) reported a survival rate of 66.1% (95% CI 55.4–76.2%), while studies non-TBI (15 studies, 262 patients) reported a survival rate of 68.1% (95% CI 56.9–78.5%). No significant difference was observed between these two survival comparisons (p = 0.623). Notably, studies utilizing venoarterial extracorporeal membrane oxygenation (VA ECMO) (15 studies, 39.0%, 95% CI 23.3–55.6%) demonstrated significantly lower survival rates than those using venovenous extracorporeal membrane oxygenation (VV ECMO) (23 studies, 72.3%, 95% CI 63.2–80.7%, p < 0.001). The graded assessment of evidence provided a high degree of certainty regarding the pooled survival.
Conclusions
ECMO is now considered beneficial for severely traumatized patients, improving prognosis and serving as a valuable tool in managing trauma-related severe cardiorespiratory failure, haemorrhagic shock, and cardiac arrest.
The emergency department thoracotomy remains controversial. We sought to explore the correlation between trauma center practices with regard to emergency department thoracotomy performance and survival of patients admitted to these centers. We hypothesized that centers that perform emergency department thoracotomies liberally would not necessarily have increased survival. Level I and II trauma centers contributing data to the National Trauma Data Bank between 2007 and 2011 were included. The data were aggregated and the counts for emergency department thoracotomies and emergency department deaths were calculated for each center. Centers were then divided into quartiles based on the emergency department thoracotomies:emergency department deaths ratio. A multivariate logistic regression model was utilized to calculate the adjusted odds ratio for mortality. The primary outcome was overall mortality. A total of 174 trauma centers admitting 1,432,811 subjects were included. The median EDT:EDD ratio ranged from 0 for Q1 to 17.6% for centers in the highest quartile (Q4). Q4 centers were more likely to be level I (Q4: 67.4% vs. Q1: 44.2%, p = 0.03) and an academic center (Q4: 67.4% vs. Q1: 41.9%, p = 0.05). Compared to patients admitted to Q1 centers, those admitted to Q4 centers had a higher adjusted mortality (adjusted odds ratio: 1.1, 95% CI 1.02–1.10, adjusted p < 0.01). Trauma centers where emergency department thoracotomies are liberally performed had a higher adjusted mortality. Further investigation is required to identify areas for improvement and standardization of the management of the trauma patient in extremis.
