title: Extracorporeal life support use in pediatric trauma: a review of the National Trauma Data Bank.
abstract: OBJECTIVE
  As the role of extracorporeal life support (ECLS) continues to evolve in the adult and pediatric populations, smaller studies and case reports have described successful use of ECLS in specific groups of pediatric trauma patients. To further define the role of ECLS in pediatric trauma, we examined indications and outcomes for use of ECLS in injured children using a large national database.
  
  
  METHODS
  All trauma patients ≤18years old were identified from the 2007 to 2011 National Trauma Data Bank. We collected patient demographics, mechanism of injury, injury severity, use of ECLS, and survival to discharge. Children undergoing ECLS were compared to those who did not undergo ECLS, using a 3:1 propensity matched analysis to compare outcomes between ECLS and non-ECLS patients with similar injury patterns.
  
  
  RESULTS
  Of 589,895 pediatric trauma patients identified, 36 patients underwent ECLS. Within the ECLS cohort, 21/36 (58%) survived, and 10/36 (28%) were discharged directly home. Most ECLS patients were between 15 and 18years 20/36 (56%). Mechanisms of injury (MOI) resulting in ECLS use included: motor vehicle collision (MVC) 16/36 (44%), gunshot wound (GSW) 6/36 (17%), burns 6/36 (17%), and drowning/suffocation (D/S) 5/36 (14%). Among the ECLS cohort, survival varied by MOI from 75% in D/S to 56% in MVC and 33% in GSW and was 55% in patients with significant head injuries. Using propensity analysis for matched injury patterns, survival for ECLS and non-ECLS patients was similar (58% vs. 65%, p=0.61).
  
  
  CONCLUSIONS
  In the largest study to date of ECLS support in pediatric trauma patients, we found encouraging survival rates to discharge, comparable to patients not undergoing ECLS with similar injuries. These results support further use and focused research of ECLS in pediatric trauma, including drowning, burn, and MVC victims and those with significant head injuries.
  
  
  METHODS
  Level III; treatment study.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Watson
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Jina
authors.initials: J
authors.lastname: Kim
authors.affiliation: Division of Pediatric Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Obinna O
authors.initials: OO
authors.lastname: Adibe
authors.affiliation: Division of Pediatric Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Rice
authors.affiliation: Division of Trauma, Duke University Medical Center, Durham, NC.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Shapiro
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Mani A
authors.initials: MA
authors.lastname: Daneshmand
authors.affiliation: Division of Pediatric Surgery, Duke University Medical Center, Durham, NC. Electronic address: elisabeth.tracy@duke.edu.
authors.forename: Elisabeth T
authors.initials: ET
authors.lastname: Tracy
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010351:Patient Discharge; D012189:Retrospective Studies; D015996:Survival Rate; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
keywords: Extracorporeal life support; Extracorporeal membranous oxygenation; Pediatric trauma