title: A National Perspective on ECMO Utilization Use in Patients with Burn Injury.
abstract: Extracorporeal membranous oxygenation (ECMO) has become an increasingly utilized used strategy to support patients in cardiac and cardiopulmonary failure. The Extracorporeal Life Support Organization reports adult survival rates between 40 and 50%. Utilization Use and outcomes for burned patients undergoing ECMO are poorly understood. The National Burn Repository (version 8.0) was queried for patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) procedure codes for ECMO. Demographics, comorbidities, mechanism, injury details, and clinical outcomes were recorded. ECMO patients were matched one-to-one to those not requiring ECMO based on age, gender, TBSA, and inhalation injury. Group comparisons were made utilizing using χ2 and Mann-Whitney U tests. Thirty ECMO-treated burn patients were identified. Patients were predominantly male (80.0%) and Caucasian (63.3%) with mean age 38.9 ± 20.3 years. The majority were flame injuries (80.0%) of moderate size (17.0 ± 18.7% TBSA), affecting predominantly upper limbs and trunk. Inhalation injury was reported in 26.7%. Respiratory failure was reported in nine, acute respiratory distress syndrome in three, and pneumonia in nine. Fourteen patients survived to discharge. The ECMO cohort had significantly higher rates of cardiovascular comorbidities, concomitant major thoracic trauma, pneumonia, acute renal failure, and sepsis than non-ECMO patients (P < .05). Ventilator usage, intesive care unit (ICU) length of stay, and mortality were also significantly higher in those treated by ECMO (P < .05). Although burn patients placed on ECMO have significantly higher rates of morbidity and mortality than those not requiring ECMO, the mortality rate is equivalent to patients reported by Extracorporeal Life Support Organization. ECMO is a viable option for supporting critically injured burn patients.
authors.affiliation: Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Nosanov
authors.affiliation: Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: McLawhorn
authors.affiliation: Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Mariana
authors.initials: M
authors.lastname: Vigiola Cruz
authors.affiliation: Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Shupp
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality / Q000628:therapy*; D012042:Registries; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D015208:Smoke Inhalation Injury / Q000401:mortality / Q000628:therapy; D013898:Thoracic Injuries / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult