Veno-arterial extracorporeal membrane oxygenation use in trauma: a retrospective analysis of the Japanese nationwide trauma registry

Abstract Background: Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and vital organ oxygenation and is potentially useful as a bridge therapy in some trauma cases. We aimed to demonstrate the characteristics and outcomes of patients with trauma treated with veno-arterial ECMO (VA-ECMO) using data from a Japanese nationwide trauma registry. Methods: This retrospective descriptive study analyzed data from the Japan Trauma Data Bank between January 2019 and December 2021. Patients with severe trauma (injury severity score [ISS] ≥ 9) and treated using VA-ECMO were assessed. Results: Among the 72,439 patients with severe trauma, 51 received VA-ECMO. Sixteen patients (31.3%) survived until hospital discharge. On hospital arrival, six (37.5%) survivors and 15 (42.9%) non-survivors experienced cardiac arrest. The median ISS for the survivor and non-survivor group was 25 (range, 25–39) and 25 (range, 17–33), respectively. Thoracic trauma was the most common type of trauma in both groups. In the non-survivor group, open-chest cardiopulmonary resuscitation, aortic cross-clamping, and resuscitative endovascular balloon occlusion of the aorta were performed in 10 (28.6%), 5 (14.3%), and 4 (11.4 %) patients, respectively. However, these procedures were not performed in the survivor group. Percutaneous oxygen saturation tended to be lower in the survivor group both before and upon arrival at the hospital. Conclusions: The results of this study suggest the potential benefit of VA-ECMO in some challenging trauma cases. Further studies are warranted to assess the indications for VA-ECMO in patients with trauma.