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

Abstract

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.

Pneumonectomy following penetrating trauma with ECMO as postoperative support: case report – (Lung trauma and ECMO)

“…This approach provided time to improve metabolic homeostasis. Recent meta-analyses indicate that ECMO is beneficial for severely traumatized patients by improving their prognosis and serving as a valuable tool in managing severe trauma-related cardiorespiratory failure, hemorrhagic shock, and cardiac arrest [ 8 ].…”

“…Despite these challenges, advancements in device technology have led to improved outcomes and reduced bleeding rates, establishing ECMO as a viable strategy in managing acute severe dysfunction [ 6 , 7 ]. A recent meta-analysis describes the prognosis for adult trauma patients requiring ECMO, concluding that it is beneficial for severely traumatized patients by improving their prognosis and serving as a valuable tool in managing severe trauma-related cardiorespiratory failure, hemorrhagic shock, and cardiac arrest [ 8 ]. The use of ECMO to support the recovery of a patient after a pneumonectomy could be a tool for supporting the heart in right ventricular dysfunction and in cases of developed acute respiratory distress syndrome (ARDS).…”

A Comprehensive Review of Extra Corporeal Membrane Oxygenation: The Lifeline in Critical Moments

“…In this context, ECMO serves as a temporary life support system, providing a dual mechanism of respiratory oxygenation and circulatory assistance. By taking over the functions of the heart and lungs, ECMO allows vital organs to rest and recover, offering a crucial bridge until the patient stabilizes or more definitive interventions can be pursued [17].…”

“…ECMO provides respiratory and circulatory support, stabilizing the patient in critical conditions where traditional methods may not be sufficient. By temporarily taking over vital functions, ECMO creates a therapeutic window for addressing the underlying trauma or septic process [17].…”

Spezielle intensivmedizinische Behandlungskonzepte des schweren Thoraxtraumas

“…Bei erhöhten Blutungsrisiken (z. B. Schädel-Hirn-Trauma, traumaassoziierte Koagulopathie) wurde hinsichtlich des Antikoagulationsbedarfs der Extrakorporalzirkulation der erfolgreiche Einsatz von Low-Dose-, verzögerten oder heparinfreien ECMO-Konzepten oder beschichteten Leitungen berichtet [35].…”