Application and outcomes of extracorporeal life support in emergency general surgery and trauma

Abstract

Background: We analyzed the use of Extracorporeal Membranous Oxygenation (ECMO) in acute care surgery patients at our Level-1 trauma center. We hypothesized that this patient population has improved ECMO outcomes. Methods: This was a retrospective analysis of emergency general surgery and trauma patients placed on ECMO between the periods of October 2013 and February 2020. There were 10 surgical and 12 trauma patients studied, who eventually required ECMO support. ECMO support and ECMO type/modality were analyzed with injury and survival prognostic scores examined. Main results: Overall, 16 of the 22 patients survived to hospital discharge, for a survival rate of 73%. Mean age was 34.18 years. Mean hospital length of stay was 23.4 days with mean days on ECMO equal to 7.5. The net negative fluid balance was 5.36 L. Conclusions: The survival of our ECMO cohort is notably higher than previously cited studies. Our group demonstrated decreased length of time on ECMO, decreased length of stay in the hospital, and similar rates of complications compared to prior reports. ECMO is a useful modality in acute care surgical patients and should be considered in these patient populations. Our focus on net negative fluid balance for ECMO patients demonstrates improved survival. ECMO should be considered early in surgical patients and early in advanced trauma life support.

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

“…After assessing the full text, 111 more studies were removed. Eventually, a total of 36 eligible publications [ 3 – 5 , 8 – 10 , 14 – 16 , 22 – 48 ] with 1822 patients were included in this meta-analysis. The PRISMA 2020 flow chart for this study is presented in Fig.…”

“…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 ].…”