A National Perspective on ECMO Utilization in Patients with Burn Injury

Abstract

Extracorporeal membranous oxygenation (ECMO) has become an increasingly utilized used strategy to support patients in cardiac and cardiopulmonary failure. The Extracorporeal Life Support Organization reports adult survival rates between 40 and 50%. Utilization Use and outcomes for burned patients undergoing ECMO are poorly understood. The National Burn Repository (version 8.0) was queried for patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) procedure codes for ECMO. Demographics, comorbidities, mechanism, injury details, and clinical outcomes were recorded. ECMO patients were matched one-to-one to those not requiring ECMO based on age, gender, TBSA, and inhalation injury. Group comparisons were made utilizing using χ2 and Mann-Whitney U tests. Thirty ECMO-treated burn patients were identified. Patients were predominantly male (80.0%) and Caucasian (63.3%) with mean age 38.9 ± 20.3 years. The majority were flame injuries (80.0%) of moderate size (17.0 ± 18.7% TBSA), affecting predominantly upper limbs and trunk. Inhalation injury was reported in 26.7%. Respiratory failure was reported in nine, acute respiratory distress syndrome in three, and pneumonia in nine. Fourteen patients survived to discharge. The ECMO cohort had significantly higher rates of cardiovascular comorbidities, concomitant major thoracic trauma, pneumonia, acute renal failure, and sepsis than non-ECMO patients (P < .05). Ventilator usage, intesive care unit (ICU) length of stay, and mortality were also significantly higher in those treated by ECMO (P < .05). Although burn patients placed on ECMO have significantly higher rates of morbidity and mortality than those not requiring ECMO, the mortality rate is equivalent to patients reported by Extracorporeal Life Support Organization. ECMO is a viable option for supporting critically injured burn patients.

Extracorporeal Membrane Oxygenation in Patients with Burns, Hero or Futile Medical Care? A Systematic Review and Meta-Analysis

“…In recent decades, ECMO has become an essential tool in the care of patients with severe cardiac and pulmonary dysfunctions that are refractory to conventional management [10,11,50]. [23,[25][26][27][28][29][30][31]. In this study, our meta-analysis revealed a pooled SMR of 2.07, suggesting a two-fold higher mortality rate compared to the predicted mortality in patients receiving ECMO therapy.…”

“…Soussi et al in 2016 reported 91% in-hospital mortality rate in 11 burn patients receiving ECMO therapy, suggesting that ECMO treatment for burn patients is not advisable [3]. However, in the last few years, several observational studies have revealed favourable outcomes from the use of ECMO [23,[25][26][27][28][29][30][31]. In this study, our meta-analysis revealed a pooled SMR of 2.07, suggesting a two-fold higher mortality rate compared to the predicted mortality in patients receiving ECMO therapy.…”

“…Due to the insu cient patient numbers from the available literature, along with limited evidence, the role of ECMO in patients with burn and inhalation injuries is unclear [2]. In recent years, several case series and retrospective studies have been performed, but the ndings still vary [3,[22][23][24][25][26][27][28][29][30][31][32]. Randomised controlled trials of ECMO compared to conventional therapy might be the solution.…”

A Review of Burn Patients Requiring Extracorporeal Membrane Oxygenation at a Burns Facility

“…This correlates to a number of other papers published over the last 25 years, from a variety of settings, quoting survival rates of 28% to 87.5% in adults. These were all small volume cohorts [12][13][14][15][16][17][18][19][20][21].…”

ECMO Therapy in a Patient with Extensive Burns, Inhalation Injury, and Blunt Chest Trauma

“…This study, by Nosanov and colleagues, reported a survival rate in the ECMO cohort (47%) that falls within the range of the overall mortality rate for all patients treated with ECMO as reported by the Extracorporeal Life Support Organization (55%). 4 In the trauma literature, multiple studies have demonstrated the survival benefit of ECMO in trauma patients with severe respiratory compromise. Despite an increased rate of bleeding complications and overall morbidity, ECMO use in the general trauma population has produced survival rates of 50 per cent to 71 per cent.…”