Outcomes of Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome in Pediatric Trauma Patients.

Q4 Medicine Critical care explorations Pub Date : 2024-09-10 eCollection Date: 2024-09-01 DOI:10.1097/CCE.0000000000001150
Nasim Ahmed, Yen-Hong Kuo
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Abstract

Importance: Acute respiratory distress syndrome (ARDS) is associated with high mortality and morbidity. Extracorporeal membrane oxygenation (ECMO) is one of the interventions that have been in practice for ARDS for decades.

Objectives: The purpose of the study was to investigate the outcomes of ECMO in pediatric trauma patients who suffered from ARDS.

Design: Observational cohort study.

Setting and participants: The Trauma Quality Improvement Program database for years 2017 to 2019 and 2021 through 2022 was accessed for the study. All children younger than 18 years old who were admitted to the hospital after trauma and suffered from ARDS were included in the study. Other variables included in the study were patients' demographics, clinical characteristics, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, comorbidities, and outcomes.

Main outcomes and measures: ECMO is the exposure, and the outcomes are in-hospital mortality and hospital complications (acute kidney injury [AKI], pneumonia and deep vein thrombosis [DVT]).

Results: Of 453 patients who qualified for the study, propensity score matching found 50 pairs of patients. There were no significant differences identified between the groups, ECMO+ vs. ECMO- on patients' age in years (16 yr; interquartile range [IQR], 13.25-17 yr vs. 16 yr [14.25-17 yr]), race (White; 62.0% vs. 66.0%), sex (male; 78% vs. 76%), ISS (23 [IQR, 9.25-34] vs. 22 [9.25-32]), and GCS (15 [IQR, 3-15] vs. 13.5 [3-15]), mechanism of injury; and comorbidities. There was no difference between the groups, ECMO+ vs. ECMO-, in-hospital mortality (10.0% vs. 20.0%; p = 0.302), hospital complications (AKI 12.0% vs. 2.0%; p = 0.131), pneumonia (10.0% vs. 20.0%; p = 0.182 > ), and DVT (16% vs. 6%; p = 0.228).

Conclusions and relevance: No difference in mortality was observed in injured children who suffered from the ARDS and were placed on ECMO when compared with patients who were not placed on ECMO. Patients with trauma and ARDS who require ECMO have comparable outcomes to those who do not receive ECMO. A larger sample size study is needed to find the exact benefit of ECMO in this patients' cohort.

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体外膜氧合治疗小儿创伤患者急性呼吸窘迫综合征的效果。
重要性:急性呼吸窘迫综合征(ARDS)的死亡率和发病率都很高。体外膜肺氧合(ECMO)是几十年来治疗 ARDS 的干预措施之一:本研究旨在调查 ECMO 对患有 ARDS 的儿科创伤患者的治疗效果:观察性队列研究:研究访问了 2017 年至 2019 年和 2021 年至 2022 年的创伤质量改进计划数据库。所有创伤后入院并患有 ARDS 的 18 岁以下儿童均纳入研究。研究中的其他变量包括患者的人口统计学特征、临床特征、损伤严重程度评分(ISS)、格拉斯哥昏迷量表(GCS)评分、合并症和结果:主要结果和测量指标:ECMO是暴露,结果是院内死亡率和住院并发症(急性肾损伤[AKI]、肺炎和深静脉血栓形成[DVT]):在 453 名符合研究条件的患者中,倾向评分匹配找到了 50 对患者。ECMO+ 组与 ECMO- 组在患者年龄(16 岁;四分位数间距 [IQR],13.25-17 岁 vs. 16 岁 [14.25-17 岁])、种族(白人;62.0% vs. 66.0%)、性别(男性;78% vs. 76%)、ISS(23 [IQR, 9.25-34] vs. 22 [9.25-32])和 GCS(15 [IQR, 3-15] vs. 13.5 [3-15])、损伤机制和合并症。ECMO+ 组与 ECMO- 组之间在院内死亡率(10.0% vs. 20.0%;P = 0.302)、住院并发症(AKI 12.0% vs. 2.0%;P = 0.131)、肺炎(10.0% vs. 20.0%;P = 0.182 >)和深静脉血栓(16% vs. 6%;P = 0.228)方面没有差异:与未接受 ECMO 治疗的患者相比,患有 ARDS 并接受 ECMO 治疗的受伤儿童的死亡率没有差异。需要接受 ECMO 的外伤和 ARDS 患者与未接受 ECMO 的患者的预后相当。需要进行更大样本量的研究,以确定 ECMO 对这类患者的确切益处。
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