Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma patients with severe adult respiratory distress syndrome

Bosarge, Patrick L.; Raff, Lauren; McGwin, Gerald; Carroll, Shannon; Bellot, Scott; Diaz-Guzman, Enrique; Kerby, Jeffrey D.

doi:10.1097/ta.0000000000001068

Cited by 84 publications

(104 citation statements)

References 18 publications

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“…In addition, the National Inpatient Sample (NIS) showed a 66‐fold increase in the number of patients with trauma receiving ECMO support from 2002 to 2012 10 . This rapid adoption of ECLS may be in large part due to results of the CESAR trial, as well as dedicated studies in trauma cohorts, that demonstrated survival benefit for patients with ARDS 7,9,11,12 . The survival rate in our cohort, which approaches 60%, is comparable to patients with trauma in the ELSO registry (50%‐63%) and the NIS (52%) 10,13 …”

Section: Discussionmentioning

confidence: 63%

“…Extracorporeal membrane oxygenation (ECMO) in patients with trauma is most commonly used for refractory hypoxemia and severe acute respiratory distress syndrome (ARDS) 4 . This modality appears to be safe and may offer a survival benefit when conventional ventilatory therapies fail 5–7 . Geographic access to high‐performing centers with ECMO capabilities, however, varies considerably across the United States 8 .…”

Section: Introductionmentioning

confidence: 99%

“…4 This modality appears to be safe and may offer a survival benefit when conventional ventilatory therapies fail. [5][6][7] Geographic access to high-performing centers with ECMO capabilities, however, varies considerably across the United States. 8 We sought to investigate the trends in ECMO use for patients with trauma across trauma centers over the last decade.…”

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confidence: 99%

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Access to extracorporeal life support as a quality metric: Lessons from trauma

et al. 2020

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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 review of the National Trauma Data Bank was performed to identify all trauma patients receiving care at ECMO and non‐ECMO centers. Baseline patient characteristics and outcomes were analyzed. Adjusted odds ratio (OR) was used to compare survival at ECMO and non‐ECMO facilities. Results Between 2007 and 2015, a total of 5 781 123 patients with trauma were identified with 1 983 986 (34%) admitted to an ECMO facility and 3 797 137 (66%) admitted to a non‐ECMO facility. A total of 522 (0.03%) patients required ECMO. Both the number of patients with trauma requiring ECMO support and the number of trauma facilities utilizing ECMO increased over the 9‐year‐study period (4.9 to 13.8 patients per 100 000 admissions, and 18 to 77 centers, respectively). The mortality for ECMO patients was 40.5%. Patients with trauma admitted to ECMO facilities had more severe injuries (injury severity score: 9.0 vs 8.0; P < .001). The overall mortality was 3.3%. The adjusted OR for mortality associated with admission to an ECMO facility vs a non‐ECMO facility was 0.96 (95% confidence interval: 0.95‐0.97; adjusted P < .001). Conclusions The use of ECMO for patients with trauma is expanding. Our study demonstrates a survival benefit associated with admission to a facility with ECMO capabilities. Thus, access to ECMO is a potential quality metric for trauma centers.

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Access to extracorporeal life support as a quality metric: Lessons from trauma

et al. 2020

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“…The timing of ECMO is usually based on the severity of ARDS, as represented by severe hypoxemia despite high PEEP (PaO 2 /FiO 2 < 80 mmHg) and uncompensated hypercapnia (pH < 7.2) [22]. There is evidence that early initiation of ECMO (1.9 ± 1.4 days after onset of severe ARDS defined by Berlin definition) improves survival in trauma patients [23]. However, this study is limited by small sample size and the use of historical control.…”

Section: Timing Of Ecmo Initiation: Indications From Ventilation Pmentioning

confidence: 99%

Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

Zhang

Chen

et al. 2017

Canadian Respiratory Journal

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Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

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“…Another method is to increase the ability of a given patient to tolerate the disease, i.e., target host resilience mechanisms. So far this has largely been in the form of supportive care, which relies on mechanical ventilation and oxygenation [29,39,66].…”

Section: Host Resilience To Sars-cov and Mers-covmentioning

confidence: 99%

Host Resilience to Emerging Coronaviruses

Jamieson

2016

Future Virol.

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Recently, two coronaviruses, severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, have emerged to cause unusually severe respiratory disease in humans. Currently, there is a lack of effective antiviral treatment options or vaccine available. Given the severity of these outbreaks, and the possibility of additional zoonotic coronaviruses emerging in the near future, the exploration of different treatment strategies is necessary. Disease resilience is the ability of a given host to tolerate an infection, and to return to a state of health. This review focuses on exploring various host resilience mechanisms that could be exploited for treatment of severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus and other respiratory viruses that cause acute lung injury and acute respiratory distress syndrome.

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Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma patients with severe adult respiratory distress syndrome

Abstract: Therapeutic study, level IV.

Cited by 84 publications

References 18 publications

Access to extracorporeal life support as a quality metric: Lessons from trauma

Access to extracorporeal life support as a quality metric: Lessons from trauma

Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

Host Resilience to Emerging Coronaviruses

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