Extracorporeal cardiopulmonary resuscitation in trauma patients: An analysis of the ELSO registry

BACKGROUND: Cardiac arrest in trauma patients can occur from traumatic or non-traumatic aetiologies. Traditionally, trauma has been regarded a contraindication for extracorporeal life support, particularly extracorporeal cardiopulmonary resuscitation (ECPR).

METHODS: In this retrospective study, the Extracorporeal Life Support Organisation registry was screened for adult trauma patients receiving ECPR (01/01/2020-01/12/2024). We reported characteristics, reasons of cardiac arrest, complications and survival of trauma patients receiving ECPR because of a traumatic cardiac arrest and trauma patients receiving ECPR because of a cardiac arrest of medical aetiology.

RESULTS: Of 13,132 ECPR patients in the registry, 134 (1.0 %) were included. Twenty-four trauma patients (17.9 %) received ECPR because of a traumatic cardiac arrest. Penetrating trauma was the injury mechanism in 50 %. Haemorrhagic shock (33.3 %), respiratory failure (29.2 %), pericardial tamponade (25.0 %), and other pathologies (12.5 %) were traumatic reasons for cardiac arrest. Hospital survival in trauma patients receiving ECPR because of a traumatic cardiac arrest was 29.2 % (7/24). One-hundred-ten trauma patients (82.1 %) underwent ECPR because of a cardiac arrest of medical aetiology. All trauma patients with out-of-hospital cardiac arrests of medical aetiology (20.3 %) had an acute cardiac condition. Acute heart failure (n = 10), pulmonary embolism (n = 10), and sepsis (n = 6) were the most common reasons for in-hospital arrests of medical aetiology (79.7 %). Hospital survival in trauma patients receiving ECPR because of a cardiac arrest of medical aetiology was 37.3 % (41/110).

CONCLUSIONS: ECPR can be used to restore circulation in trauma patients with cardiac arrest. ECPR may result in higher-than-expected survival rates, even when applied in patients with traumatic cardiac arrest.