Trauma Extracorporeal Membrane Oxygenation in Argentina: Complications, Mortality, and Long-term Outcomes.

Summary

In a four-center Argentine cohort of trauma-related ARDS on VV-ECMO (n=31), in-hospital mortality was 38.7% and bleeding (25.8%) and circuit thrombosis (22.6%) were common. Long-term follow-up showed preserved independence (Katz 6) among survivors, while ISS, APACHE II, and RESP scores had poor discrimination.

Key Findings

• In-hospital mortality was 38.7% with VV-ECMO; bleeding occurred in 25.8% (major 16.1%) and oxygenator/circuit thrombosis in 22.6%.
• Established prognostic scores showed poor discrimination: AUROC 0.62 (ISS), 0.55 (APACHE II), 0.53 (RESP).
• Among survivors with median 7-year follow-up, EQ-5D-3L utility median was 0.743 and Katz Index 6, indicating preserved independence despite frequent pain/anxiety.

Clinical Implications

VV-ECMO can achieve meaningful survival with preserved independence in trauma ARDS, but clinicians should anticipate bleeding and thrombosis risks and plan structured rehabilitation and follow-up. Trauma-specific prognostic models are needed to support selection and counseling.

Limitations

• Small sample size and substantial loss to follow-up limit precision and generalizability.
• Retrospective assessment of complications and mortality may introduce bias.

Future Directions

Develop trauma-specific ECMO prognostic tools and establish prospective registries with standardized rehabilitation and long-term follow-up.