(1576) ECMO in Pediatric Traumatic Brain Injury: Prevalence and Outcome

Introduction: Trauma continues to be one of the leading causes of hospitalizations and death in the pediatric population, with approximately 3-5% of all pediatric deaths being attributed to traumatic brain injury (TBI). Rarely, patients who suffer traumatic injuries have respiratory and/or cardiac failure severe enough to require extracorporeal life support (ECLS), but few studies have described this in the pediatric population. In this study, we describe the outcomes of pediatric subjects who underwent extracorporeal membrane oxygenation (ECMO) therapy with a TBI compared to those who sustained other mechanisms of traumatic injury.

Methods: A retrospective analysis of the Extracorporeal Life Support Organization (ELSO) ECMO database from 1998-2021 was performed. Inclusion criteria were age > 28 days to < 18 years and traumatic injury. Subjects with TBI were identified using appropriate ICD-9 and 10 codes and were compared to those without TBI. Statistical analysis done via Python Programming.

Results: Of the 1883 pediatric subjects requiring ECMO who sustained any form of trauma, 110 were identified as having sustained a TBI. Most were male (68.2%) and white (53.6%). The most prevalent age group was 13-18 years old (49.1%), followed by 2-5 years old (18.2%), 28 days to 1 years old (16.4%) and 6-12 years old (16.4%). The average hours on ECMO for subjects with TBI was 181.3 hours vs. 201.3 hours for those that did not have TBI (p=0.50). Children with TBI had a higher rate of intracranial hemorrhages (9.1% vs 2.4%, [OR:4.02, p=0.001]), but similar rates of central nervous system infarction or ischemia (8.2% vs 7.5%, [OR: 1.10, p=0.94]), and seizures (4.5% vs. 6.1%, [OR:0.73, p=0.63]). There was no significant difference in mortality between those with TBIs and those without (44.4% vs. 43.8%, p=0.97).

Conclusions: Children who have suffered a TBI and require ECMO have similar ECMO duration and mortality rates compared to those who suffer traumatic injury without TBI. TBI is associated with a higher risk of intracranial hemorrhage, although is not associated with other neurological complications. Our study suggests that clinicians should not use the presence of TBI alone to preclude initiating ECMO, though careful attention needs to be paid to the cerebral bleeding risk present in these children.