ECMO in trauma: What are the outcomes?

摘要

We read with interest the case series and systematic review of extracorporeal membrane oxygenation (ECMO) for ARDS in trauma by Robba et al. They report that of 31 trauma patients who required ECMO (27 from systematic literature review and 4 in their institutional case series) only 4 died, with a survival rate of 87.1%. This survival rate was noted to be high compared to other published institutional, national and international ECMO reports. The use of ECMO in the trauma population has been reported to have a survival benefit in patients with severe refractory hypoxic respiratory failure. Critical appraisal of available evidence is important in assessing high-cost critical care therapies. But this current review includes only selected case reports and series based on a desire to focus on anticoagulation management in this population. We believe this introduced a significant positive outcome bias in the results since most case reports are used by authors to report interventions that result in favorable outcomes. Consequently, the authors present a serious misrepresentation of the ECMO survival rate which is a significant limitation of this review.