Assessment of safety and bleeding risk in the use of extracorporeal membrane oxygenation for multitrauma patients: A multicenter review

BACKGROUND: Respiratory failure is the most common form of organ failure following traumatic injury. Previously, there have been concerns regarding extracorporeal membrane oxygenation (ECMO) use in the trauma setting because of the increased risk of bleeding and thrombotic complications. We sought to examine the management of trauma patients with ECMO and to assess the safety and outcome of its use. METHODS: Data of all patients who experienced a traumatic injury and were supported with ECMO were collected from the five National Respiratory ECMO centers in the United Kingdom over the period from December 2011 to May 2017. Primary outcome variables included 30-day and 6-month mortality and exacerbation of underlying traumatic injury after ECMO commencement. Secondary outcome variables included duration of ECMO support, thrombotic complications, and worsening of intracranial injury. RESULTS: Fifty-two patients were identified. The overall hospital mortality was 15%. The incidence of bleeding complications was 50%, the majority of these not requiring intervention. Forty patients underwent surgical management prior to ECMO commencement; only four patients required take-back to the operating theater. There was no significant difference between the bleeding and nonbleeding groups in time of injury to ECMO commencement (median difference, 4.5 days; 95% CI, -3 to 3 days; p = 0.75). There was no statistically significant difference between the bleeding and nonbleeding groups in regard to time to anticoagulation commencement after starting ECMO (median difference, - 1 hour; 95% CI, -48 to 2 hours; p = 0.29) or after trauma (median difference, - 1 day; 95% CI, -4 to 2 days; p = 0.41). Nineteen patients were diagnosed with significant neurological injury. Twelve of these patients were anticoagulated. Two patients died as a direct result of worsening neurological injury. CONCLUSIONS: Our findings suggest that the use of ECMO in trauma patients does not exacerbate primary traumatic injury regardless of anticoagulation commencement and may confer a survival benefit. Neurological injury should not be seen as an absolute contraindication to ECMO. LEVEL OF EVIDENCE: Therapeutic/Care Management, Level V.