Use of ECMO support in pediatric patients with severe thoracic trauma
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In brief
In brief
Retrospective study of 6 pediatric patients with severe chest trauma requiring ECMO support showed 83% survival but significant complications including stroke and neurologic deficits. ECMO may be lifesaving in select pediatric thoracic trauma cases, though careful patient selection is critical given bleeding risks and morbidity.
Written by the GCMD Library team from the article.
Background
Extracorporeal membrane oxygenation (ECMO) has been used in the non-trauma setting for over 30 years. However, the use of ECMO in trauma remains a difficult question, as the risk of bleeding must be weighed against the benefits of cardiopulmonary support.
Methods
Retrospective review of children who sustained severe thoracic trauma (chest abbreviated injury score ≥3) and required ECMO support between 2009 and 2016.
Results
Of the 425 children who experienced severe thoracic trauma, 6 (1.4%) underwent ECMO support: 67% male, median age 4.8 years, median ISS 36, median GCS 3, and overall survival 83%. The median hospital day of ECMO initiation was 2 with a median ECMO duration of 7 days. All cannulations occurred through the right neck regardless of the size of the child. Five initially had veno-venous support with 1 requiring conversion to veno-arterial (VA) support. Both children on VA support suffered devastating cerebrovascular accidents, one of which ultimately led to withdrawal of care and death. Complications in the cohort included: paraplegia (1), neurocognitive defects/dysphonia (1), infected neck hematoma (1), deep femoral venous thrombosis (1), bilateral lower extremity spasticity (1).
Conclusion
This small cohort supports the use of ECMO in children with severe thoracic injuries as a potentially lifesaving intervention, however, not without significant complication.
Level of Evidence
IV.