Swol J, et al. - Researchers undertook a multi-institutional study assessing the indications and outcomes of extracorporeal life support (ECLS) in trauma. Analysis of data from the largest registry of critically ill trauma patients receiving ECLS support displayed reasonable survival. Growing experience and improved safety profile support not considering trauma a contraindication for ECLS.

Methods

• Adult (≥16 years) trauma patients receiving ECLS support in the Extracorporeal Life Support Organization (ELSO) registry (1989–2016) were retrospectively reviewed.
• Researchers included patient demographics, diagnoses, and ECLS technique and procedures in the standardized data from the contributing ELSO centers.
• Furthermore, they recorded baseline characteristics, precannulation and postcannulation physiologic data, complications, and outcomes.
• Categorization of survival was performed both by transition off ECLS support and survival to hospital discharge.

Results

• Researchers identified 279 trauma patients (0.92% of 30,273 adult ECLS patients).
• Compared with 106 in the prior 18 years, the last 5 years showed a significant increase in extracorporeal life support (173 in 2011–2016, 62%). 
• Predominantly male (78%) comprised the trauma patients, with a mean age of 34.8 ± 15.4 years (range, 16–88 years).
• The most common diagnosis was thoracic injury; the most common indication was acute respiratory distress syndrome. 
• In this study, extracorporeal life support was venovenous for respiratory failure (89%), VA for cardiac failure (7%), and VA for ECLS-assisted cardiopulmonary resuscitation (CPR) (E-CPR) (4%). 
• They observed extracorporeal life support duration of 8.8 ± 9.5 days (longest 83 days); the duration was longer for respiratory support (9.3 ± 9.3 days) vs cardiac support (4.1 ± 4.5 days) and E-CPR (6.5 ± 16.8 days).
• The total cohort showed the overall survival from ECLS of 70% and survival to hospital discharge of 61% (63% respiratory, 50% cardiac, 25% E-CPR), this was similar to survival rates observed in other ELSO registry cohorts.
• During ECLS support, complication were reported in more than 80% of patients.
• They identified cardiovascular (51%) complication as the most common complication followed by a bleeding complication (29%).
• The most common cause of death included multiple organ failure (15.4%).