Nationwide Utilization of Cardiopulmonary Bypass in Cardiothoracic Trauma: A Retrospective Analysis of the National Trauma Data Bank

Background

The American College of Surgeons Committee on Trauma requires that all level I trauma centers have cardiopulmonary bypass (CPB) capabilities immediately available. Despite this mandate, there is limited data on the utilization and clinical outcomes among trauma patients requiring CPB in the management of injuries. The aim of this study was to evaluate the current use of CPB in the care of trauma patients.

Methods

This is a retrospective analysis of the National Trauma Data Bank from 2010 to 2015. Adult patients sustaining cardiothoracic injuries who underwent surgical repair within the first 24 hours of admission were included. Propensity score matching was used to compare outcomes (in-hospital mortality, hospital length of stay, ICU length of stay, and complications) between patients who underwent CPB within the first 24 hours of admission to those with similar injuries who did not receive CPB.

Results

28,481 patients were identified who met inclusion criteria, of whom 319 underwent CPB. 303 CPB patients were matched to 895 comparison patients who did not undergo CPB. Overall in-hospital mortality was 35%. Patients who were not treated with CPB had a significantly higher in-hospital mortality compared to those treated with CBP (OR 1.57, 95% CI; 1.16, 2.12, p = 0.003), however complications were significantly lower in those who did not receive CPB (OR 0.63, CI 95%; 0.47, 0.86, P = 0.003). Hospital length of stay (non-CPB: mean 13.4 ± 16.3 days; CPB mean 14.7 ± 15.1 days, p = 0.23) and ICU length of stay (non-CPB: mean 9.9 ± 10.7 days; CPB mean: 10.1 ± 9.7 days, p = 0.08) did not differ significantly between groups.

Conclusions

The use of CPB in the initial management of select cardiothoracic injuries is associated with a survival benefit. Further investigation is required to delineate which specific injuries would benefit the most from the use of CPB.