Predictors of mortality in trauma patients with acute respiratory distress syndrome receiving extracorporeal membrane oxygenation

• Published in: Surgery in practice and science Vol. 9; p. 100071
• Main Authors: Abate, Miseker, Grigorian, Areg, Lekawa, Michael, Schubl, Sebastian, Dolich, Matthew, T Delaplain, Patrick, M Kuza, Catherine, Nahmias, Jeffry
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.06.2022; Elsevier
• Subjects: Acute Respiratory Distress Syndrome; Age-related mortality; Extracorporeal membrane oxygenation; Surgery; Trauma; Trauma Quality Improvement Program; Age-related mortality; Extracorporeal membrane oxygenation; Trauma; Surgery; Acute Respiratory Distress Syndrome; Trauma Quality Improvement Program
• ISSN: 2666-2620; 2666-2620
• DOI: 10.1016/j.sipas.2022.100071

Trauma-related Acute Respiratory Distress Syndrome (TR-ARDS) mortality ranges from 30 to 80%. Extracorporeal membrane oxygenation (ECMO) has demonstrated a survival benefit in select cases of TR-ARDS. In order to provide improved patient selection, we evaluated predictors of mortality in TR-ARDS patients receiving ECMO, hypothesizing age and severe thoracic trauma as risk factors for mortality. The Trauma Quality Improvement Program (2010–2016) was queried for patients ≥ 18-years-old with TR-ARDS receiving ECMO. Survivors were compared to those who died. A multivariable logistic regression model was used for analysis and included covariates known to increase risk of mortality in trauma patients. From 362 TR-ARDS patients on ECMO, 226 (62.4%) survived and 136 (37.6%) died. Those who died were older (median, 28 vs. 24-years-old, p = 0.036) and had a higher injury severity score (29 vs. 26, p = 0.040) than survivors. After adjusting for covariates, independent predictors of mortality included a severe head (OR=2.66, CI=1.29–5.49, p = 0.008) and thorax (OR =3.52, CI=1.96–6.33, p < 0.001) injury. Age ≥ 65-years-old was not a predictor of mortality (p = 0.432). Age ≥ 65 years did not appear to increase the risk of mortality in patients with TR-ARDS receiving ECMO. However, those with severe head or thorax injury had more than a two-fold and three-fold increased risk of death, respectively. TR-ARDS patients differ from medical ARDS patients in terms of etiology, age and injuries. Thus, prior pre-ECMO mortality prediction models may lack predictive capability for trauma patients. Future prospective studies are needed to confirm our findings and develop guidelines for utilization of ECMO for trauma patients.