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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Extracorporeal membrane oxygenation in traumatic brain injury – a retrospective, multicentre cohort study

Extrakorporale Membranoxygenierung beim Schädel-Hirn-Trauma – eine retrospektive, Multicenterstudie

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  • Marius Marc-Daniel Mader - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland; Stanford University School of Medicine, Institute for Stem Cell Biology and Regenerative Medicine, Stanford, CA, Vereinigte Staaten
  • Rolf Lefering - Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin (IFOM), Köln, Deutschland
  • Marc Maegele - Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Köln, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • presenting/speaker Patrick Czorlich - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV213

doi: 10.3205/22dgnc206, urn:nbn:de:0183-22dgnc2068

Published: May 25, 2022

© 2022 Mader et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Patients with moderate to severe traumatic brain injury (TBI) with or without relevant concomitant injuries are usually treated on intensive care units (ICUs) with invasive ventilation. Consequently, these patients are at increased risk of lung failure, potentially requiring extracorporeal membrane oxygenation (ECMO). The aim of this work is to provide an overview of ECMO treatment in TBI based upon data captured into the German TraumaRegistry (TR-DGU).

Methods: A retrospective multi-center cohort analysis of patients registered in into the TR-DGU was conducted. Adult patients with relevant TBI (AIS Head ≥3) who had been treated in German, Austrian, and Swiss level 1 or 2 trauma centers between 2015 and 2019 were included. Multivariable logistic regression analysis was performed to identify early risk factors associated with need for ECMO treatment.

Results: 16,513 patients fulfilled the inclusion criteria and were analyzed. The overall rate of ECMO treatment was 0.8% (134 patients) with the highest rate of 1.03% among16-59 year old patients. Patients on ECMO had an overall hospital mortality rate of 38.1% (51/134 patients) while 12.5% (2055/16.379patients) of TBI patients without ECMO died. Risk factors for ECMO were male gender (p=0.029), AISChest 4 (p=0.048), AISChest 5 (p=0.008) and packed red blood cell (pRBC) transfusion (1-9 pRBC (p<0.001), ≥ 10 pRBC (p=0.002)).

Conclusion: ECMO therapy is a key component to the treatment of moderate-to-severe TBI combined with severe chest trauma and pulmonary failure. Even though associated with higher in-hospital mortality, the majority of ECMO patients is surviving. Severe chest trauma and pRBC transfusion are potential early predictors for the need of ECMO in the further clinical course of TBI patients.