Extracorporeal membrane oxygenation in traumatic brain injury – A retrospective, multicenter cohort study

  • Marius Marc-Daniel Mader
    Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Federal Republic of Germany

    Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
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  • Rolf Lefering
    Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Federal Republic of Germany
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  • Manfred Westphal
    Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Federal Republic of Germany
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  • Marc Maegele
    Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Federal Republic of Germany

    Department for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Federal Republic of Germany
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  • Patrick Czorlich
    Corresponding author.
    Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Federal Republic of Germany
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Published:January 03, 2023DOI:


      • This manuscript first describes the ECMO rate in TBI patients, which is 1.1%.
      • 61.9% of all TBI patients treated with ECMO were discharged alive.
      • TBI patients with ECMO treatment present with a higher rate of a severe chest trauma and a higher rate of packed red blood cell transfusion.



      Patients with traumatic brain injury (TBI) regularly require intensive care with prolonged invasive ventilation. Consequently, these patients are at increased risk of pulmonary failure, potentially requiring extracorporeal membrane oxygenation (ECMO). The aim of this work was to provide an overview of ECMO treatment in TBI patients based upon data captured into the TraumaRegister DGU® (TR-DGU).


      A retrospective multi-center cohort analysis of patients registered in the TR-DGU was conducted. Adult patients with relevant TBI (AISHead ≥3) who had been treated in German, Austrian, or Swiss level I or II trauma centers using ECMO therapy between 2015 and 2019 were included. A multivariable logistic regression analysis was used to identify risk factors for the need for ECMO treatment.


      12,247 patients fulfilled the inclusion criteria. The overall rate of ECMO treatment was 1.1% (134 patients). Patients on ECMO had an overall hospital mortality rate of 38% (51/134 patients) while 13% (1523/12,113 patients) of TBI patients without ECMO therapy died. Male gender (p = 0.014), AISChest 3+ (p<0.001), higher Injury Severity Score (p<0.001) and packed red blood cell (pRBC) transfusion (p<0.001) were associated with ECMO treatment.


      ECMO therapy is a potentially lifesaving modality for the treatment of moderate-to-severe TBI when combined with severe chest trauma and pulmonary failure. The in-hospital mortality is increased in this high-risk population, but the majority of patients is surviving.


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