Extracorporeal Life Support for Trauma

Hamera, Joseph; Menne, Ashley

doi:10.1016/j.emc.2022.09.012

Cited by 3 publications

(1 citation statement)

References 29 publications

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“…ECMO assumes the role of an support when conventional therapeutic interventions fall short in addressing circulatory and respiratory failure. Venovenous (VV) ECMO and venoarterial (VA) ECMO are two perfusion methods used, with VV ECMO providing respiratory support and VA ECMO providing both respiratory and circulatory support [ 5 – 7 ]. While ECMO use continues to expand in non-trauma scenarios, its application in trauma patients remains controversial in many centers [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

ECMO in adult patients with severe trauma: a systematic review and meta-analysis

Zhang,

Huang

et al. 2023

Eur J Med Res

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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.

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Section: Introductionmentioning

confidence: 99%