Characteristics And Outcomes Of Extracorporeal Life Support In Pediatric Trauma Patients
Christopher A Behr1, Stephen J Strotmeyer1, Justyna Swol2, *Barbara A Gaines1
1UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA;2University Hospital Würzburg, Würzburg, Germany
Background: Extracorporeal life support (ECLS) has been used in the pediatric population for numerous indications, but its use in trauma has been understudied and at times controversial. We sought to examine the indications, characteristics, and outcomes of children placed on ECLS for trauma.
Methods: We performed a retrospective review of all pediatric trauma patients in the Extracorporeal Life Support Organization (ELSO) registry from 1989 - 2018. Patient characteristics, indications for ECLS, pre and post-ECLS ventilator settings and blood chemistry, complications and survival rates were examined. Categories were stratified by mode: veno-venous (VV), veno-arterial (VA), or conversion. Data was analyzed using SPSS software, with significance considered at p<0.05.
Results: We identified 689 patients with an average age of 6.65 years. The majority of patients (59.8%) were male and on VA support (54.3%). Drowning (32.4%) was the most common mechanism, followed by burns (17.6%), foreign bodies (16.6%) and thoracic trauma (14.9%). Complication rates were high (80.5%), with the most frequent types being cardiovascular, mechanical and hemorrhagic. Incidences of complications (overall and by type) were similar to those reported in other ELSO cohorts. Overall survival was 59%, and was significantly higher (p=0.00) for patients on VV (77%) compared to those on VA (47.5%), even when controlling for mechanism.
Conclusions: Survival and complication rates of pediatric trauma patients on ECLS are comparable to those reported for other indications. Trauma should not be considered a contraindication for ECLS.
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