Abate Miseker, Grigorian Areg, Lekawa Michael, Schubl Sebastian, Dolich Matthew, T Delaplain Patrick, M Kuza Catherine, Nahmias Jeffry
University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298, USA.
Department of General Surgery, New York Presbyterian Hospital, Weill Cornell, USA.
Surg Pract Sci. 2022 Mar 23;9:100071. doi: 10.1016/j.sipas.2022.100071. eCollection 2022 Jun.
Trauma-related Acute Respiratory Distress Syndrome (TR-ARDS) mortality ranges from 30 to 80%. Extracorporeal membrane oxygenation (ECMO) has demonstrated a survival benefit in select cases of TR-ARDS. In order to provide improved patient selection, we evaluated predictors of mortality in TR-ARDS patients receiving ECMO, hypothesizing age and severe thoracic trauma as risk factors for mortality.
The Trauma Quality Improvement Program (2010-2016) was queried for patients ≥ 18-years-old with TR-ARDS receiving ECMO. Survivors were compared to those who died. A multivariable logistic regression model was used for analysis and included covariates known to increase risk of mortality in trauma patients.
From 362 TR-ARDS patients on ECMO, 226 (62.4%) survived and 136 (37.6%) died. Those who died were older (median, 28 vs. 24-years-old, = 0.036) and had a higher injury severity score (29 vs. 26, = 0.040) than survivors. After adjusting for covariates, independent predictors of mortality included a severe head (OR=2.66, CI=1.29-5.49, = 0.008) and thorax (OR =3.52, CI=1.96-6.33, < 0.001) injury. Age ≥ 65-years-old was not a predictor of mortality ( = 0.432).
Age ≥ 65 years did not appear to increase the risk of mortality in patients with TR-ARDS receiving ECMO. However, those with severe head or thorax injury had more than a two-fold and three-fold increased risk of death, respectively. TR-ARDS patients differ from medical ARDS patients in terms of etiology, age and injuries. Thus, prior pre-ECMO mortality prediction models may lack predictive capability for trauma patients. Future prospective studies are needed to confirm our findings and develop guidelines for utilization of ECMO for trauma patients.
创伤相关急性呼吸窘迫综合征（TR-ARDS）的死亡率在30%至80%之间。体外膜肺氧合（ECMO）已在部分TR-ARDS病例中显示出生存获益。为了改进患者选择，我们评估了接受ECMO的TR-ARDS患者的死亡预测因素，假设年龄和严重胸部创伤为死亡风险因素。
查询创伤质量改进项目（2010 - 2016年）中年龄≥18岁且接受ECMO的TR-ARDS患者。将幸存者与死亡者进行比较。采用多变量逻辑回归模型进行分析，纳入已知会增加创伤患者死亡风险的协变量。
在362例接受ECMO的TR-ARDS患者中，226例（62.4%）存活，136例（37.6%）死亡。死亡者年龄更大（中位数，28岁对24岁，P = 0.036），且损伤严重程度评分更高（29对26，P = 0.040）。在对协变量进行调整后，死亡的独立预测因素包括严重头部损伤（OR = 2.66，CI = 1.29 - 5.49，P = 0.008）和胸部损伤（OR = 3.52，CI = 1.96 - 6.33，P < 0.001）。年龄≥65岁不是死亡的预测因素（P = 0.432）。
年龄≥65岁似乎并未增加接受ECMO的TR-ARDS患者的死亡风险。然而，严重头部或胸部损伤的患者死亡风险分别增加了两倍多和三倍多。TR-ARDS患者在病因、年龄和损伤方面与医疗性ARDS患者不同。因此，之前的ECMO前死亡预测模型可能对创伤患者缺乏预测能力。未来需要进行前瞻性研究来证实我们的发现，并制定针对创伤患者使用ECMO的指南。
