An epidemiological analysis of extracorporeal membrane oxygenation use in trauma

Background Trauma is the leading cause of death in younger adults and children. Severe polytrauma predisposes patients to the failure of multiple organ systems, including the cardiovascular and respiratory systems, at times necessitating extracorporeal membrane oxygenation (ECMO). ECMO use in the setting of trauma is increasing, yet little data exists describing current practice patterns. We performed an epidemiological analysis of ECMO use and outcomes in trauma patients. Study design and methods We analyzed data from the Trauma Quality Improvement Program Registry from 2017 to 2023. Procedure codes were used to identify the application of ECMO. Pediatric patients were those < 18 years of age. We analyzed two groups from this data set: one including all patients who required ECMO and a separate group including only pediatric cases. We used descriptive and inferential statistical methods. Results There were 8,014,737 encounters of which 1919 had documented ECMO use. Within that group, 224 were < 18 years of age. The median time from hospital arrival to the first initiation of ECMO was 44 h (interquartile range [IQR] 5–147). The incidence per year ranged from 1.9 to 2.9 events per 10,000 encounters. Survival ranged from 59% to 68% per year. The number of facilities with documented ECMO use annually ranged from 103 to 158 and overall increased during the time of the study. Interfacility transfer was common but was not related to survival. Discussion ECMO use demonstrated steady growth in the number of performing facilities throughout the study period. Survival was similar to previous reports. Our findings will help inform targeted clinical guidelines for the use of ECMO in adult and pediatric trauma populations.