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Use of extracorporeal membranous oxygenation in the management of refractory trauma-related severe acute respiratory distress syndrome: a national survey of the Eastern Association for the Surgery of Trauma
  1. Lauren Raff1,
  2. Jeffrey David Kerby2,
  3. Donald Reiff2,
  4. Jan Jansen2,
  5. Eric Schinnerer3,
  6. Gerald McGwin4,
  7. Patrick Bosarge5
  1. 1Trauma and Acute Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3Acute Care Surgery, St. John Trauma Services, Tulsa, Oklahoma, USA
  4. 4Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  5. 5Acute Care Surgery, University of Phoenix, Phoenix, Arizona, USA
  1. Correspondence to Dr Lauren Raff, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; lauren_raff{at}med.unc.edu

Abstract

Objective To report results of a national survey of provider attitudes, observations, and opinions regarding the use of extracorporeal membranous oxygenation (ECMO) to manage severe acute respiratory distress syndrome (ARDS) in trauma patients.

Design A survey was created to query providers on the use of ECMO in trauma, as well as general management principals related to care of the patient with refractory hypoxic respiratory failure. The survey was sent to all members of Eastern Association for the Surgery of Trauma (EAST). Once completed, the survey was returned to the University of Alabama at Birmingham and results were analyzed.

Setting/patients Trauma patients with refractory ARDS.

Interventions None.

Measurements and main results Respondents were from 37 states, the District of Columbia, and Puerto Rico. 56.9% reported institutional ECMO capabilities, but only 45.2% reported using ECMO for trauma patients. Most respondents (90.2%) reported ECMO use in less than or equal to five trauma patients per year. 20.9% think there is not enough data to support its use in trauma but only 4.7% would absolutely not consider ECMO use for trauma patients. Ranking the preferred modality of treatments for refractory ARDS from most to least preferable is as follows: airway pressure release ventilation, bilevel ventilation, paralysis, prone positioning, inhaled nitric oxide, epoprostenol, high-frequency oscillatory ventilation, corticosteroids, surfactant.

Conclusions ARDS has a high mortality among trauma patients. Despite its utility in treating severe ARDS and other pulmonary disease processes, ECMO has not been universally embraced by the trauma community. There are an increasing number of studies that suggest that ECMO is a safe and viable treatment option for trauma patients with ARDS. Based on the results of this survey, ECMO use remains limited by trauma providers that care for patients with refractory hypoxic respiratory failure and ARDS, likely due to a combination of knowledge gaps and lack of access to ECMO.

Level of evidence Level V.

  • ards
  • ecmo
  • survey

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors All authors contributed to the completion of this study, with survey generation, data collection and analysis or writing and editing of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article. Data are available upon reasonable request.

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