Comprehensive Summary
This retrospective study used data from the Extracorporeal Life Support Organisation (ELSO) registry to evaluate the use and outcomes of Extracorporeal Cardiopulmonary Resuscitation (ECPR) in adult trauma patients with cardiac arrest. Of 13,132 ECPR cases recorded, 134 trauma patients treated with ECPR between January 2020 and December 2024 met the inclusion criteria. The study aimed to describe patient characteristics, arrest etiologies, clinical course, and hospital survival outcomes. Among the 110 trauma patients (82.1%) whose cardiac arrest was due to a medical cause such as heart failure, pulmonary embolism, or sepsis, the hospital survival rate was 37.3%. The remaining 24 patients with traumatic cardiac arrest from causes such as hemorrhagic shock, respiratory failure, or tamponade had a hospital survival rate of 29.2%.
Outcomes and Implications
Trauma patients can experience cardiac arrest from both traumatic or non-traumatic causes. Historically, extracorporeal cardiopulmonary resuscitation (ECPR) has been contraindicated in the presence of trauma due to bleeding risk and concerns about futility. However, this study demonstrates that ECPR in trauma patients experiencing cardiac arrest can result in higher-than-expected survival rates, even in cases directly related to traumatic injury. Therefore, trauma may not necessarily be a contraindication for extracorporeal life support. Limitations include the study’s retrospective, registry-based design, small sample size, and lack of detailed information on injury severity or long-term outcomes. Future prospective multicenter trials are warranted to validate these findings and guide the expansion of ECPR eligibility in trauma-associated cardiac arrest.