Extracorporeal life support in trauma: Worth the risks? A systematic review of published series.

BACKGROUND: Extracorporeal life support (ECLS) is a potentially life-saving procedure for trauma patients with severe respiratory failure. Despite this, only a limited number of publications report series of trauma patients who underwent ECLS. The performance and safety of this technology in trauma patients is not fully understood. We described the efficacy and complications of ECLS in trauma patients with respiratory failure.
METHODS: A systematic review of published reports was performed utilizing the Medical Literature Analysis and Retrieval System Online (MEDLINE). Studies reporting ECLS in five trauma patients or more were examined for eligibility. Eligible trials were examined for patient characteristics, trauma characteristics, and anticoagulation management. Outcomes were examined for survival, causes of overall mortality, and the incidence of bleeding-related mortality.
RESULTS: Six hundred five studies were identified in the initial literature search. Of these, 12 studies met the inclusion and exclusion criteria with a total of 215 patients. The overall survival to discharge ranged from 50% to 79%. Survival to discharge after venovenous-ECLS and venoarterial-ECLS were different, ranging from 56% to 89% and 42% to 63%, respectively. The leading cause of mortality was sepsis, which was the cause in 48% of all deaths. Bleeding-related mortality ranged between 0% and 38%, and was consistently lower than 15% in studies after 1995. Reported patients with traumatic intracranial hemorrhage (ICH) had survival ranging from 60% to 93%, with no mortalities related to their ICH. There was a recent trend towards initially heparin-free circuitry followed by a lower-than-standard activated clotting time target range.
CONCLUSION: The use of ECLS in trauma patients when needed may provide survival benefits that significantly overweigh the feared risk of bleeding associated. LEVEL OF EVIDENCE: Systematic review, level III.