VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION IMPROVES OUTCOMES IN TRAUMA PATIENTS SUFFERING RESPIRATORY FAILURE.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE SHOCK Pub Date : 2024-10-24 DOI:10.1097/SHK.0000000000002491

Elizabeth K Powell, Richard Betzold, Daniel T Lammers, Jamie Podell, Ryan Wan, William Teeter, Ronald D Hardin, Thomas M Scalea, Samuel M Galvagno

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Abstract

Introduction: Veno-venous extracorporeal membrane oxygenation (VV ECMO) improves hypoxemia and carbon dioxide clearance in patients with severe respiratory derangements. A greater understanding of the potential benefits of VV ECMO in trauma patients could lead to broader adoption. We hypothesize that trauma patients who receive VV ECMO have improved mortality outcomes when compared to those receiving conventional ventilator management given the rapid stabilization VV ECMO promotes.

Methods: We performed a single center, propensity score matched cohort study. All trauma patients from January 1, 2014, to October 30, 2023, who were placed on VV ECMO or who would have met institutional guidelines for VV ECMO but were managed with conventional ventilator strategies were matched 1:1. The primary outcome analysis was survival at hospital discharge. Significance was defined as p < 0.05.

Results: Eighty-one trauma VV ECMO patients and 128 patients who received conventional management met criteria for inclusion. After matching, VV ECMO and conventional treatment cohort characteristics were similar in age and MOI. Matched ISS, SI, lactate levels, and frequency of TBI were also similar. Finally, respiratory parameters including pre-intervention, pH, partial pressure of carbon dioxide (PaCO2), lactate levels, and oxygen saturation were similar between matched groups. VV ECMO patients had higher survival rates at discharge when compared to the matched conventional treatment group (70% v 41%, p < 0.001). Corresponding hazard ratio for VV ECMO use was 0.31 (95%CI 0.18-0.52; p < 0.001). The odds ratio of mortality in matched trauma patients who receive VV ECMO versus conventional treatment was 0.29 (95%CI 0.14-0.58; p < 0.001).

Conclusion: VV ECMO may represent a safe, alternative treatment approach for appropriately screened trauma patients with acute respiratory failure, however further studies are warranted.

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静脉体外膜氧合可改善呼吸衰竭的创伤患者的预后。

简介静脉体外膜氧合（VV ECMO）可改善严重呼吸失调患者的低氧血症和二氧化碳清除率。更深入地了解 VV ECMO 对创伤患者的潜在益处，将有助于更广泛地采用 VV ECMO。我们假设，与接受传统呼吸机管理的患者相比，接受 VV ECMO 的创伤患者的死亡率会有所改善，因为 VV ECMO 能促进患者病情的快速稳定：我们进行了一项单中心倾向得分匹配队列研究。从 2014 年 1 月 1 日到 2023 年 10 月 30 日，所有接受 VV ECMO 治疗的创伤患者或符合 VV ECMO 的机构指南但接受传统呼吸机管理的患者都进行了 1:1 匹配。主要结果分析是出院时的存活率。显著性定义为 p < 0.05：81 名外伤 VV ECMO 患者和 128 名接受常规管理的患者符合纳入标准。匹配后，VV ECMO 和常规治疗队列的年龄和死亡率特征相似。匹配的 ISS、SI、乳酸水平和 TBI 频率也相似。最后，匹配组之间的呼吸参数（包括干预前、pH 值、二氧化碳分压（PaCO2）、乳酸水平和血氧饱和度）相似。与匹配的常规治疗组相比，VV ECMO 患者出院时的存活率更高（70% 对 41%，P < 0.001）。使用 VV ECMO 的相应危险比为 0.31 (95%CI 0.18-0.52; p < 0.001)。接受 VV ECMO 与常规治疗的匹配创伤患者的死亡几率比为 0.29 (95%CI 0.14-0.58; p < 0.001)：VV ECMO 对于经过适当筛选的急性呼吸衰竭外伤患者可能是一种安全的替代治疗方法，但仍需进一步研究。

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来源期刊

SHOCK 医学-外科

CiteScore

6.20

自引率

3.20%

发文量

199

审稿时长

1 months

期刊介绍： SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.