Timing of Extracorporeal Membrane Oxygenation and Outcomes in Adult Patients With Moderate-Severe Blunt Thoracic Trauma

Background: There is mixed evidence on the optimal timing of veno-venous extracorporeal membrane oxygenation (VV-ECMO) following significant trauma. Objective: This study aims to assess the timing of VV-ECMO initiation and its effect on clinical outcomes in adult patients with moderate-severe blunt thoracic trauma. Methods: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) database between 2015 and 2023 to evaluate the clinical effects of VV-ECMO in adult patients (≥18 years) with blunt, moderate-severe thoracic and thoraco-abdominal trauma. Outcomes of interest included in-hospital mortality, intensive care unit length of stay (ICU-LOS), complications such as deep vein thrombosis, pulmonary embolism, acute kidney injury, and discharge disposition. Results: There were 412 adult patients with moderate-severe blunt thoracic and thoraco-abdominal trauma who received VV-ECMO, of which 256 (61.8%) were initiated within ≤7 days and 105 (25.4%) after 7 days. Patients with VV-ECMO initiation within ≤7 days had no difference in mortality rates (adjusted odds ratio [aOR] .655, p = .246) but had five fewer ICU-LOS days (β: −5.364, p = .002). Additionally, patients receiving early VV-ECMO were less likely to be discharged home (aOR: .192, p = .017) than all other discharge dispositions. No differences were observed in transfusion needs or complication rates. Conclusion: Initiation of VV-ECMO within ≤7 days was associated with significantly shorter ICU-LOS and comparable odds of mortality, without significant differences in complications or adverse events, including transfusion requirements and venous thromboembolism. Trauma and critical care societies should consider these findings when revisiting existing ECMO protocols concerning the early initiation of VV-ECMO to improve outcomes in this population.