Indications and outcomes of extracorporeal life support in trauma patients

Justyna Swol, Daniel Brodie, Lena Napolitano, Pauline K. Park, Ravi Thiagarajan, Ryan P. Barbaro, Roberto Lorusso, David McMullan, Nicholas Cavarocchi, Ali Ait Hssain, Peter Rycus, David Zonies

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND The use of extracorporeal life support (ECLS) in the trauma population remains controversial and has been reported only in small cohort studies. Recent ECLS technical advances have increased its use as an advanced critical care option in trauma. Given the degree of resource utilization, costs, and expertise required to provide ECLS support in trauma patients, we sought to perform a multi-institutional study to assess the indications and outcomes of ECLS in trauma. METHODS A retrospective review of adult (≥16 years) trauma patients receiving ECLS support in the Extracorporeal Life Support Organization (ELSO) registry (1989-2016) was performed. Standardized data from the contributing ELSO centers includes patient demographics, diagnoses, and ECLS technique and procedures. Additionally, baseline characteristics, precannulation and postcannulation physiologic data, complications, and outcomes were recorded. Survival was categorized both by transition off ECLS support and survival to hospital discharge. RESULTS Two hundred seventy-nine trauma patients were identified (0.92% of 30,273 adult ECLS patients). Extracorporeal life support increased significantly in the last 5 years (173 in 2011-2016, 62%) compared with 106 in the prior 18 years. Trauma patients were predominantly male (78%), with a mean age of 34.8 ± 15.4 years (range, 16-88 years). Thoracic injury was the most common diagnosis; acute respiratory distress syndrome was the most common indication. Extracorporeal life support was venovenous for respiratory failure (89%), VA for cardiac failure (7%), and VA for ECLS-Assisted cardiopulmonary resuscitation (CPR) (E-CPR) (4%). Extracorporeal life support duration was 8.8 ± 9.5 days (longest 83 days), and was longer for respiratory support (9.3 ± 9.3 days) vs. cardiac support (4.1 ± 4.5 days) and E-CPR (6.5 ± 16.8 days). Overall survival from ECLS was 70% and survival to hospital discharge was 61% in the total cohort (63% respiratory, 50% cardiac, 25% E-CPR), similar to survival rates in other ELSO registry cohorts. More than 80% of patients had a reported complication during ECLS support. The most common complication was cardiovascular (51%) followed by a bleeding complication (29%). Multiple organ failure was the most common cause of death (15.4%). CONCLUSION Data from the largest registry of critically ill trauma patients receiving ECLS support demonstrates reasonable survival. With growing experience and improved safety profile, trauma should not be considered a contraindication for ECLS. Further analysis of the ELSO registry regarding trauma-specific risk factors and ECLS-specific practices may identify best candidates and improve trauma ECLS outcomes. LEVEL OF EVIDENCE Therapeutic study, level III.

Original languageEnglish (US)
Pages (from-to)831-837
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume84
Issue number6
DOIs
StatePublished - Jun 1 2018

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Extracorporeal Membrane Oxygenation
Wounds and Injuries
Cardiopulmonary Resuscitation
Registries
Survival
Organizations

Keywords

  • ARDS
  • cardiac failure
  • extracorporeal life support
  • extracorporeal membrane oxygenation
  • respiratory failure
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Indications and outcomes of extracorporeal life support in trauma patients. / Swol, Justyna; Brodie, Daniel; Napolitano, Lena; Park, Pauline K.; Thiagarajan, Ravi; Barbaro, Ryan P.; Lorusso, Roberto; McMullan, David; Cavarocchi, Nicholas; Hssain, Ali Ait; Rycus, Peter; Zonies, David.

In: Journal of Trauma and Acute Care Surgery, Vol. 84, No. 6, 01.06.2018, p. 831-837.

Research output: Contribution to journalArticle

Swol, J, Brodie, D, Napolitano, L, Park, PK, Thiagarajan, R, Barbaro, RP, Lorusso, R, McMullan, D, Cavarocchi, N, Hssain, AA, Rycus, P & Zonies, D 2018, 'Indications and outcomes of extracorporeal life support in trauma patients', Journal of Trauma and Acute Care Surgery, vol. 84, no. 6, pp. 831-837. https://doi.org/10.1097/TA.0000000000001895
Swol, Justyna ; Brodie, Daniel ; Napolitano, Lena ; Park, Pauline K. ; Thiagarajan, Ravi ; Barbaro, Ryan P. ; Lorusso, Roberto ; McMullan, David ; Cavarocchi, Nicholas ; Hssain, Ali Ait ; Rycus, Peter ; Zonies, David. / Indications and outcomes of extracorporeal life support in trauma patients. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 84, No. 6. pp. 831-837.
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abstract = "BACKGROUND The use of extracorporeal life support (ECLS) in the trauma population remains controversial and has been reported only in small cohort studies. Recent ECLS technical advances have increased its use as an advanced critical care option in trauma. Given the degree of resource utilization, costs, and expertise required to provide ECLS support in trauma patients, we sought to perform a multi-institutional study to assess the indications and outcomes of ECLS in trauma. METHODS A retrospective review of adult (≥16 years) trauma patients receiving ECLS support in the Extracorporeal Life Support Organization (ELSO) registry (1989-2016) was performed. Standardized data from the contributing ELSO centers includes patient demographics, diagnoses, and ECLS technique and procedures. Additionally, baseline characteristics, precannulation and postcannulation physiologic data, complications, and outcomes were recorded. Survival was categorized both by transition off ECLS support and survival to hospital discharge. RESULTS Two hundred seventy-nine trauma patients were identified (0.92{\%} of 30,273 adult ECLS patients). Extracorporeal life support increased significantly in the last 5 years (173 in 2011-2016, 62{\%}) compared with 106 in the prior 18 years. Trauma patients were predominantly male (78{\%}), with a mean age of 34.8 ± 15.4 years (range, 16-88 years). Thoracic injury was the most common diagnosis; acute respiratory distress syndrome was the most common indication. Extracorporeal life support was venovenous for respiratory failure (89{\%}), VA for cardiac failure (7{\%}), and VA for ECLS-Assisted cardiopulmonary resuscitation (CPR) (E-CPR) (4{\%}). Extracorporeal life support duration was 8.8 ± 9.5 days (longest 83 days), and was longer for respiratory support (9.3 ± 9.3 days) vs. cardiac support (4.1 ± 4.5 days) and E-CPR (6.5 ± 16.8 days). Overall survival from ECLS was 70{\%} and survival to hospital discharge was 61{\%} in the total cohort (63{\%} respiratory, 50{\%} cardiac, 25{\%} E-CPR), similar to survival rates in other ELSO registry cohorts. More than 80{\%} of patients had a reported complication during ECLS support. The most common complication was cardiovascular (51{\%}) followed by a bleeding complication (29{\%}). Multiple organ failure was the most common cause of death (15.4{\%}). CONCLUSION Data from the largest registry of critically ill trauma patients receiving ECLS support demonstrates reasonable survival. With growing experience and improved safety profile, trauma should not be considered a contraindication for ECLS. Further analysis of the ELSO registry regarding trauma-specific risk factors and ECLS-specific practices may identify best candidates and improve trauma ECLS outcomes. LEVEL OF EVIDENCE Therapeutic study, level III.",
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author = "Justyna Swol and Daniel Brodie and Lena Napolitano and Park, {Pauline K.} and Ravi Thiagarajan and Barbaro, {Ryan P.} and Roberto Lorusso and David McMullan and Nicholas Cavarocchi and Hssain, {Ali Ait} and Peter Rycus and David Zonies",
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T1 - Indications and outcomes of extracorporeal life support in trauma patients

AU - Swol, Justyna

AU - Brodie, Daniel

AU - Napolitano, Lena

AU - Park, Pauline K.

AU - Thiagarajan, Ravi

AU - Barbaro, Ryan P.

AU - Lorusso, Roberto

AU - McMullan, David

AU - Cavarocchi, Nicholas

AU - Hssain, Ali Ait

AU - Rycus, Peter

AU - Zonies, David

PY - 2018/6/1

Y1 - 2018/6/1

N2 - BACKGROUND The use of extracorporeal life support (ECLS) in the trauma population remains controversial and has been reported only in small cohort studies. Recent ECLS technical advances have increased its use as an advanced critical care option in trauma. Given the degree of resource utilization, costs, and expertise required to provide ECLS support in trauma patients, we sought to perform a multi-institutional study to assess the indications and outcomes of ECLS in trauma. METHODS A retrospective review of adult (≥16 years) trauma patients receiving ECLS support in the Extracorporeal Life Support Organization (ELSO) registry (1989-2016) was performed. Standardized data from the contributing ELSO centers includes patient demographics, diagnoses, and ECLS technique and procedures. Additionally, baseline characteristics, precannulation and postcannulation physiologic data, complications, and outcomes were recorded. Survival was categorized both by transition off ECLS support and survival to hospital discharge. RESULTS Two hundred seventy-nine trauma patients were identified (0.92% of 30,273 adult ECLS patients). Extracorporeal life support increased significantly in the last 5 years (173 in 2011-2016, 62%) compared with 106 in the prior 18 years. Trauma patients were predominantly male (78%), with a mean age of 34.8 ± 15.4 years (range, 16-88 years). Thoracic injury was the most common diagnosis; acute respiratory distress syndrome was the most common indication. Extracorporeal life support was venovenous for respiratory failure (89%), VA for cardiac failure (7%), and VA for ECLS-Assisted cardiopulmonary resuscitation (CPR) (E-CPR) (4%). Extracorporeal life support duration was 8.8 ± 9.5 days (longest 83 days), and was longer for respiratory support (9.3 ± 9.3 days) vs. cardiac support (4.1 ± 4.5 days) and E-CPR (6.5 ± 16.8 days). Overall survival from ECLS was 70% and survival to hospital discharge was 61% in the total cohort (63% respiratory, 50% cardiac, 25% E-CPR), similar to survival rates in other ELSO registry cohorts. More than 80% of patients had a reported complication during ECLS support. The most common complication was cardiovascular (51%) followed by a bleeding complication (29%). Multiple organ failure was the most common cause of death (15.4%). CONCLUSION Data from the largest registry of critically ill trauma patients receiving ECLS support demonstrates reasonable survival. With growing experience and improved safety profile, trauma should not be considered a contraindication for ECLS. Further analysis of the ELSO registry regarding trauma-specific risk factors and ECLS-specific practices may identify best candidates and improve trauma ECLS outcomes. LEVEL OF EVIDENCE Therapeutic study, level III.

AB - BACKGROUND The use of extracorporeal life support (ECLS) in the trauma population remains controversial and has been reported only in small cohort studies. Recent ECLS technical advances have increased its use as an advanced critical care option in trauma. Given the degree of resource utilization, costs, and expertise required to provide ECLS support in trauma patients, we sought to perform a multi-institutional study to assess the indications and outcomes of ECLS in trauma. METHODS A retrospective review of adult (≥16 years) trauma patients receiving ECLS support in the Extracorporeal Life Support Organization (ELSO) registry (1989-2016) was performed. Standardized data from the contributing ELSO centers includes patient demographics, diagnoses, and ECLS technique and procedures. Additionally, baseline characteristics, precannulation and postcannulation physiologic data, complications, and outcomes were recorded. Survival was categorized both by transition off ECLS support and survival to hospital discharge. RESULTS Two hundred seventy-nine trauma patients were identified (0.92% of 30,273 adult ECLS patients). Extracorporeal life support increased significantly in the last 5 years (173 in 2011-2016, 62%) compared with 106 in the prior 18 years. Trauma patients were predominantly male (78%), with a mean age of 34.8 ± 15.4 years (range, 16-88 years). Thoracic injury was the most common diagnosis; acute respiratory distress syndrome was the most common indication. Extracorporeal life support was venovenous for respiratory failure (89%), VA for cardiac failure (7%), and VA for ECLS-Assisted cardiopulmonary resuscitation (CPR) (E-CPR) (4%). Extracorporeal life support duration was 8.8 ± 9.5 days (longest 83 days), and was longer for respiratory support (9.3 ± 9.3 days) vs. cardiac support (4.1 ± 4.5 days) and E-CPR (6.5 ± 16.8 days). Overall survival from ECLS was 70% and survival to hospital discharge was 61% in the total cohort (63% respiratory, 50% cardiac, 25% E-CPR), similar to survival rates in other ELSO registry cohorts. More than 80% of patients had a reported complication during ECLS support. The most common complication was cardiovascular (51%) followed by a bleeding complication (29%). Multiple organ failure was the most common cause of death (15.4%). CONCLUSION Data from the largest registry of critically ill trauma patients receiving ECLS support demonstrates reasonable survival. With growing experience and improved safety profile, trauma should not be considered a contraindication for ECLS. Further analysis of the ELSO registry regarding trauma-specific risk factors and ECLS-specific practices may identify best candidates and improve trauma ECLS outcomes. LEVEL OF EVIDENCE Therapeutic study, level III.

KW - ARDS

KW - cardiac failure

KW - extracorporeal life support

KW - extracorporeal membrane oxygenation

KW - respiratory failure

KW - Trauma

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