The use of ECMO in pediatric trauma resuscitation: A contemporary multicenter study

Abstract

Background: Trauma remains the leading cause of death in all age groups of children, yet the role of extracorporeal membrane oxygenation (ECMO) in pediatric trauma remains unclear. The goal of this study was to evaluate contemporary ECMO practice patterns for pediatric trauma in both acute (<24 hours of trauma) and subacute (≥24 hours) settings.

Methods: Multicenter, retrospective study of children aged 0-20 years cannulated to ECMO after a trauma (Total Study Population). Collected data included trauma mechanism, complications, and outcomes. A sub-cohort termed Traumatic Injury Population excluded patients cannulated after drowning or foreign body aspiration (FBA).

Results: Eleven centers contributed data from 55 children (average age, 8.3 years; male, 53%) cannulated between 2006 and 2022. The most common trauma mechanisms were drowning (20%) and motor vehicle collision (MVC) (15%). The Total Study Population survival was 69% (38/55). Of children cannulated acutely, the most common trauma events were MVC (18%) and cold-water drowning (15%) while in children cannulated subacutely, they were burn (19%) and all-terrain vehicle accident (19%). Survival was significantly improved in the acute cohort compared with subacute cohort (62% vs. 68%, p = 0.04). In the Traumatic Injury Population, overall survival was 67% (28/42) with 63% of children cannulated acutely surviving compared with 69% of children cannulated subacutely ( p = 0.53). Children cannulated after FBA, cold-water drowning, and airway injury had 100% survival rate while those cannulated after penetrating thoracic or blunt abdominal injury, cardiac arrest, and cardiogenic shock had the worst survival (50%, 0%, 50%, 63%, respectively).

Conclusion: This is the largest multicenter study to date using contemporary data of children who received ECMO for a trauma indication. Compared with national nontraumatic ECMO cannulations, our overall cohort, and sub-cohort of children with traumatic injuries, had comparable survival. Children cannulated after FBA, cold-water drowning, and airway injury benefitted the most from ECMO support.

Level of evidence: Therapeutic/Care Management; Level IV.

Keywords: ECMO; extracorporeal membrane oxygenation; pediatric; trauma.