Use of Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Thoracic Trauma Patients: A case Series
Madison M Hunt, *Stephen J Fenton
University of Utah School of Medicine, Salt Lake City, UT
Background: Extracorporeal membrane oxygenation (ECMO) has been used in the non-trauma setting for over 30 years in patients with cardiopulmonary failure who have failed conventional therapies. However, the use of ECMO in the thoracic trauma setting remains a difficult question, as the risk of bleeding with anticoagulation must be weighted against the benefits of cardiopulmonary support.
Methods: The purpose of this study was to review the experience of ECMO support for children treated at a Level-1 Pediatric Trauma Center between 2009-2016 who sustained thoracic trauma injuries and were subsequently placed on ECMO support.
Findings: Seven children were identified; 71% were male with a median age of 5 years (13 months-17 years), median ISS 34 [IQR 25,40], and median GCS of 3 [IQR 3,8]. The most common mechanism was pedestrian vs. automobile (3) followed by crush injury, gunshot wound, motorcycle accident, and car accident (1 each). The most common injury was lung contusions (5), followed by inferior vena cava injury and avulsed bronchus (1 each). The median day of ECMO initiation was 2 [IQR 2,8] with a median duration of 6 days [IQR 6,8]. The cohort was roughly split between venovenous (43%) and venoarterial support (57%) with 29% requiring conversion from venovenous to venoarterial support. All patients had a head CT prior to initiating therapy without acute intracranial processes. The overall survival was 85% without major complication reported.
Conclusions: While the small number of patients limits this study’s conclusions, it does support the idea that ECMO can be safely used in children with thoracic injuries as a potentially lifesaving intervention.
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