In:
Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 88, No. 1 ( 2020-1), p. 153-159
Abstract:
Venovenous extracorporeal membrane oxygenation (ECMO) has had encouraging evidence suggesting efficacy and acceptable safety in trauma patients with refractory respiratory failure. Given the obstacles of accruing adequate quality prospective data for a resource-intensive modality, it is unclear what is indicative of survival to discharge. We investigate pre-ECMO characteristics (age, Injury Severity Score [ISS], time from admission to cannulation, P:F ratio) in trauma patients to determine correlation with survival. METHODS To address these challenges, we use Bayesian inference and patients from a level I trauma center and Extracorporeal Life Support Organization–designated Gold Center of Excellence (N = 12), published literature, and Markov chain Monte Carlo simulation to determine if there is strong predictive probability regarding survival to discharge. RESULTS Bayesian inference probabilities expressed as odds ratios with 95% credible intervals (CrIs) were as follows: age ( e βage = 0.981; CrI, 0.976–0.985), ISS ( e βISS = 0.996; CrI, 0.980–1.012), P:F ratio ( e βpf = 1.000; CrI, 0.996–1.003), and time from admission to ECMO ( e βtime = 0.988; CrI, 0.974–1.004). Bayes factors (BF) were as follows: BF age = 3.151, BF ISS = 3.564 × 10 13 , BF pf = 0.463, and BF time = 913.758. CONCLUSION Age was the only pre-ECMO factor that demonstrated the most certain effect on hospital mortality for trauma patients placed on venovenous ECMO. The ISS and time to ECMO initiation had some appreciable impact on survival although less certain than age; P:F ratio likely had none. However, the pre-ECMO factors that were found to have any impact on mortality were relatively diminutive. More studies are necessary to update prior distributions and enhance accuracy. LEVEL OF EVIDENCE Prognostic, Level IV.
Type of Medium:
Online Resource
ISSN:
2163-0763
,
2163-0755
DOI:
10.1097/TA.0000000000002457
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2020
detail.hit.zdb_id:
2651313-4
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