Extracorporeal Membrane Oxygenation May Improve Outcomes After Resuscitative Thoracotomy: A National Trauma Data Bank Analysis

2021 ◽  
pp. 000313482110242
Author(s):  
Natthida Owattanapanich ◽  
Kenji Inaba ◽  
Brad Allen ◽  
Meghan Lewis ◽  
Reynold Henry ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Survival Rates ◽  
Data Bank ◽  
Therapeutic Modality ◽  
Trauma Patients ◽  
Resuscitative Thoracotomy ◽  
Membrane Oxygenation ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
The Impact

Background Albeit low survival rates, resuscitative thoracotomy (RT) is considered standard for selected trauma patients. Because it has potential for rapid cardiopulmonary rescue, extracorporeal membrane oxygenation (ECMO) may augment RT. The aim of this study was to identify the impact of ECMO on trauma patients that recently underwent RT after injury. Study Design All patients who underwent RT were identified from the National Trauma Data Bank (2007-2017). Patients were excluded if they died within 60 minutes, underwent delayed ECMO, and/or had missing data. Delayed ECMO group was defined as those patients undergoing ECMO after 1 hour following RT. Results Out of 8 694 272 injured patients, 10 106 (.1%) underwent RT. Median age was 31 years [23-45], 86% male. Penetrating injury was the dominant mechanism (62%). Of these, .6% (23) underwent immediate ECMO. Extracorporeal membrane oxygenation patients were significantly younger (23[17-33] vs. 31[23-46], p .003) and had significantly higher chest abbreviated injury scale scores (5[4-5] vs. 3[3-4], P < .001). Extracorporeal membrane oxygenation patients achieved significantly higher rate of return of spontaneous circulation (96% vs. 70%, p .007) and had nonsignificant trend of improved mortality (52% vs. 63%, p .260). Conclusion Immediate ECMO may be a useful therapeutic modality after RT. It achieves higher ROSC rates with opportunity for improved survival. Future prospective study is warranted.

Extracorporeal Membrane Oxygenation Use in Pediatric Trauma: A Report from the National Trauma Data Bank

2020 ◽  
Vol 231 (4) ◽  
pp. S197
Author(s):  
Eric W. Etchill ◽  
Mark L. Kovler ◽  
Felipe Pedroso ◽  
Melania Bembea ◽  
Alejandro E. Garcia ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Trauma ◽  
Data Bank ◽  
Membrane Oxygenation ◽  
National Trauma ◽  
National Trauma Data Bank

Helicopter Transport Use for Trauma Patients Is Decreasing Significantly Nationwide but Remains Overutilized

2018 ◽  
Vol 84 (10) ◽  
pp. 1630-1634 ◽  
Author(s):  
Navpreet K. Dhillon ◽  
Nikhil T. Linaval ◽  
Kavita A. Patel ◽  
Christos Colovos ◽  
Ara Ko ◽  
...  
Keyword(s):  
Injury Severity ◽  
Data Bank ◽  
The United States ◽  
Trauma Patients ◽  
Effective Utilization ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Minor Injuries ◽  
Helicopter Transportation ◽  
Rapid Transfer

Rapid transfer of trauma patients to a trauma center for definitive management is essential to increase survival. The utilization of helicopter transportation for this purpose remains heavily debated. The purpose of this study was to characterize the trends in helicopter transportations of trauma patients in the United States over the last decade. Subjects with a primary mode of either ground or helicopter transportation were selected from the National Trauma Data Bank datasets 2007 to 2015. Over this period, the proportion of patients transported by a helicopter decreased significantly in a linear fashion from 17 per cent in 2007 to 10.2 per cent in 2015 ( P < 0.001). The overall mortality of this population was 7.6 per cent and remained unchanged over the study period ( P = 0.545). Almost 3 of 10 subjects (29.4%) transported by a helicopter had an Injury Severity Score <9. The proportion of elderly (>65 years) patients requiring helicopter transportation increased by 69.1 per cent, whereas their associated mortality decreased by 21.5 per cent. The use of a helicopter for the transportation of trauma patients has significantly decreased over the last decade without any significant change in mortality, possibly indicating more effective utilization of available resources. Overtriage of patients with minor injuries remained relatively unchanged.

Farm Injuries: Animal Most Common, Machinery Most Lethal: An NTDB Study

2019 ◽  
Vol 85 (7) ◽  
pp. 752-756
Author(s):  
Karl Damroth ◽  
Rachel Damroth ◽  
Asad Chaudhary ◽  
Anfin Erickson ◽  
Liam Heneghan ◽  
...  
Keyword(s):  
Injury Severity ◽  
Data Bank ◽  
Trauma Patients ◽  
Age Group ◽  
Fatality Rate ◽  
P Values ◽  
Injury Type ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Farm Injuries

To characterize both emergency room (ER) and hospital discharge dispositions of patients presenting with farm-related injuries. The 2012 National Trauma Data Bank was queried in August 2017 for injuries occurring on a farm. Patients were stratified by gender, age group, race, Injury Severity Score (ISS), and injury type. We performed logistic regression analysis to correlate parameters with likelihood of discharge home or death. P values < 0.05 were considered significant. Five thousand six hundred thirty-one patients were identified, the majority of whom were male (72%) and white (85%). The most common mechanisms of injury included animal-related (29%), followed by falls, vehicles, and other causes. The highest ISSs were seen in vehicular injuries (11% ISS of 251) and the greatest fatality rate was seen in machinery injuries (4%). Four thousand seven hundred fifty-three (84%) patients were admitted to the hospital, and 4056 (72%) were discharged home from the ER or after hospitalization. One hundred thirty patients (2%) died of their farm-related injury. Most patients presenting to the ER with farm-related injuries survive, are admitted to the hospital, and are ultimately discharged home. Few patients die of their injuries. Animal injury is most common and machinery injury most lethal of farm trauma patients presenting to the ER.

scholarly journals Survival prediction of trauma patients: a study on US National Trauma Data Bank

2017 ◽  
Vol 43 (6) ◽  
pp. 805-822 ◽  
Author(s):  
I. Sefrioui ◽  
R. Amadini ◽  
J. Mauro ◽  
A. El Fallahi ◽  
M. Gabbrielli
Keyword(s):  
Data Bank ◽  
Survival Prediction ◽  
Trauma Patients ◽  
National Trauma ◽  
National Trauma Data Bank

Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank

2019 ◽  
Vol 85 (4) ◽  
pp. 342-349 ◽  
Author(s):  
Alexander A. Xu ◽  
Janis L. Breeze ◽  
Jessica K. Paulus ◽  
Nikolay Bugaev
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Data Bank ◽  
Esophageal Injury ◽  
Trauma Patients ◽  
Adult Age ◽  
National Trauma ◽  
National Trauma Data Bank

Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.

scholarly journals Effects of the duration of bridge to lung transplantation with extracorporeal membrane oxygenation

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253520
Author(s):  
Dong Kyu Oh ◽  
Sang-Bum Hong ◽  
Tae Sun Shim ◽  
Dong Kwan Kim ◽  
Sehoon Choi ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Survival Rates ◽  
Severe Illness ◽  
Post Transplantation ◽  
Transplant Survival ◽  
Post Transplant ◽  
Membrane Oxygenation ◽  
Adjusted Model ◽  
The Impact

Background Although bridge to lung transplantation (BTT) with extracorporeal membrane oxygenation (ECMO) is increasingly performed, the impact of BTT and its duration on post-transplant outcomes are unclear. Methods We retrospectively reviewed medical records of adult patients who underwent lung or heart-lung transplantation in our institution between January 2008 and December 2018. Data were compared in patients who did (n = 41; BTT) and did not (n = 36; non-BTT) require pre-transplant ECMO support. Data were also compared in patients who underwent short-term (<14 days; n = 21; ST-BTT) and long-term (≥14 days; n = 20; LT-BTT) BTTs. Results Among 77 patients included, 51 (66.2%) were male and median age was 53 years. The median bridging time in the BTT group was 13 days (interquartile range [IQR], 7–19 days). Although simplified acute physiologic score II was significantly higher in the BTT group (median, 35; IQR, 31–49 in BTT group vs. median, 12; IQR, 7–19 in non-BTT group; p<0.001), 1-year (73.2% vs. 80.6%; p = 0.361) and 5-year (61.5% vs. 61.5%; p = 0.765) post-transplant survival rates were comparable in both groups. Comparison of ST- and LT-BTT subgroups showed that 1-year (90.5% vs. 55.0%; p = 0.009) and 5-year (73.0% vs. 48.1%; p = 0.030) post-transplant survival rates were significantly higher in ST-BTT group. In age and sex adjusted model, the LT-BTT was an independent risk factor for 1-year post-transplant mortality (hazard ratio, 3.019; 95% confidence interval, 1.119–8.146; p = 0.029), whereas the ST-BTT was not. Conclusions Despite the severe illness, the BTT group showed favorable post-transplantation outcomes, particularly those bridged for less than 14 days.

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