Venovenous extracorporeal membrane oxygenation experience in a community level I trauma center

Abstract

Background There is limited literature of venovenous extracorporeal membrane oxygenation use in a community, non-university, setting in the trauma population. Methods We reviewed our cases over 2 years from March 2018 to March 2020. This study was conducted in a community hospital with a General Surgery residency with no direct affiliation to a medical school. Primary outcome reviewed was survival to discharge. Secondary outcomes included duration of extracorporeal membranous oxygenation (ECMO) support, blood transfusion requirement, complications, and disposition. Results Five patients were cannulated during this time period. All patients survived to discharge. Mean time on ECMO was 153.4 h or 6.4 days (range 60–216 h). All patients required a transfusion while cannulated, with a mean of 10 units PRBC transfused (range 3–24). One patient required CPR, one required cessation of heparin drip for bleeding, and one had clinical signs of a stroke. Three patients were discharged to long-term acute care facilities and the other two to acute rehab. Conclusions Community level I trauma centers are capable of handling trauma patients requiring ECMO. It does require a multi-disciplinary team of surgical intensivists and cardiothoracic surgeons along with the support of nursing, respiratory therapists, and perfusionists. The outcomes in this limited series show that ECMO can be a tool utilized in the community setting.

Yesterday’s contraindications, tomorrow’s indications

“…The main limitation is that the indications for ECLS in trauma are still considered relatively rare, even in Level 1 trauma centres. 3 The case series may have been biased by patient selection and may have been too small to support recommendations or real conclusions. 4 The only way to make evidence-based recommendations is to use data from registries, such as the ELSO Registry and the newly developed Trauma Addendum, to draw conclusions that support the recommendations.…”