Veno-venous Extracorporeal Membrane Oxygenation in Patients with Traumatic Brain Injuries and Severe Respiratory Failure: A Single-Center Retrospective Analysis

Abstract Background Veno-venous extracorporeal membrane oxygenation (VV ECMO) can support trauma patients with severe respiratory failure. Use in traumatic brain injury (TBI) may raise concerns of worsening complications from intracranial bleeding. However, VV ECMO can rapidly correct hypoxemia and hypercarbia, possibly preventing secondary brain injury. We hypothesize that adult trauma patients with TBI on VV ECMO have comparable survival to trauma patients without TBI. Methods Single center, retrospective cohort study involving review of electronic medical records of trauma admissions between July 1, 2014 to August 30, 2022 with discharge diagnosis of TBI who were placed on VV ECMO during their hospital course Results Seventy-five trauma patients were treated with VV ECMO; 36 (48%) had TBI. Of those with TBI, 19 (53%) had a hemorrhagic component. Survival was similar between patients with and without a TBI (72% v 64%, p = 0.45). TBI survivors had a higher admission Glasgow Coma Scale (7 v 3, p < 0.001) than non-survivors. Evaluation of prognostic scoring systems on initial head CT demonstrated TBI VV ECMO survivors were more likely to have a Rotterdam Score of 2 (62% v 20%, p = 0.03) and no survivors had a Marshall score ≥ 4. Twenty-nine (81%) patients had a repeat head CT on VV ECMO with one incidence of expanding hematoma and one new focus of bleeding. Neither patient with a new/worsening bleed received anticoagulation. Survivors demonstrated favorable neurologic outcomes at discharge and outpatient follow-up, based on their mean Rancho Los Amigos Scale (RLAS) (6.5, SD 1.2), median Cerebral Performance Category (CPC) (2, IQR 1-2), and median Glasgow Outcome Scale-Extended (GOS-E) (7.5, IQR 7-8). Conclusions In this series, the majority of TBI patients survived and had good neurologic outcomes despite a low admission GCS. VV ECMO may minimize secondary brain injury and may be considered in select patients with TBI. Level of Evidence Level IV, Prognostic/Epidemiological