Utilization of Cardiopulmonary Bypass in Trauma Patients: A Multi-Institutional Study of the American Association for the Surgery of Trauma

BackgroundThe purpose of this descriptive study was to characterize the utilization and outcomes of CPB after trauma.MethodsThis is an AAST-sponsored retrospective (2011-2021) multicenter (32 centers) study of all adult trauma patients undergoing CPB. Univariate analysis comparing demographics, clinical characteristics and the study outcomes were performed between those who required CPB≤2 hours, >2-24 hours, and >24 hours from the arrival. The primary outcome was mortality.ResultsThere were 113 patients, 63% sustained blunt trauma. The most common injuries were cardiac (42%), thoracic aorta (42%), and pericardial tamponade (25%). The three most common reasons to use CPB were aortic repair (32%), cardiopulmonary resuscitation (20%), and cardiac repair (15%). CPB was performed within 2 hours in 44(39%), and 21(19%) underwent CPB after 24-hours. Penetrating mechanisms of injury 24 (55%) (<i>P</i> = .009), higher rate of hypotension (SBP <80 mmHg) 15 (71%) (<i>P</i> = .002) were more common in CPB≤2-hours. Septal (<i>P</i> = .001) and valvular (<i>P</i> = .002) injuries were more frequent in CPB >24 hours, otherwise there were no differences in injury patterns among CPB ≤2 hours, >2-24 hours, and >24 hours. Cardiac repair was the most common indications for CPB ≤2 hours (<i>P</i> = .002), aorta repair was more common in CPB 2-24 hours (<i>P</i> = .03). Complications were not different between CPB ≤2 hours, >2-24 hours, and >24 hours. Among survivors, no differences in terms of discharge disposition, hospital LOS were found (all <i>P</i> > .05). Mortality was 22% with 96% of them undergoing CPB in the first 24 hours (<i>P</i> < .001).ConclusionsCPB is rarely used for traumatic injuries. The true impact of CPB is unknown and should be studied in comparison to patients with cardiovascular injuries that are repaired without CPB.Level of EvidenceLevel IV; Therapeutic/Care Management.

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Journal
The American Surgeon
Published
2026-02-14
DOI
https://doi.org/10.1177/00031348261425181
Primary Topic
Trauma Management and Diagnosis
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article
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article

Utilization of Cardiopulmonary Bypass in Trauma Patients: A Multi-Institutional Study of the American Association for the Surgery of Trauma

Manish Karamchandani, James P. Byrne, Bethany Doles, Kathryn M. Stadeli et al.
The American Surgeon
Trauma Management and Diagnosis
article

Utilization of Cardiopulmonary Bypass in Trauma Patients: A Multi-Institutional Study of the American Association for the Surgery of Trauma

Manish Karamchandani, James P. Byrne, Bethany Doles, Kathryn M. Stadeli, K. Brasel, M. Jordan, Amelia W. Maiga, Melike Harfouche, Emily W Rady, Jason D. Sciarretta, Carlos VR Brown, Brian B Draper, Gabriel A. Brat, Caroline Park, Robert D. Winfield, Brendin R. Beaulieu‐Jones, Daniel R. Margulies, Michael Ghio, Travis J Miles, Galinos Barmparas, Shayan Rakhit, Bishwajit Bhattacharya, Nolan R Bruce, Jessica Staszak, Sharven Taghavi, Luis G. Fernández, Terry Jones, Jonathan Gushing, Judson B. Williams, Brandi Pero, M Kost, Terence S. O’Keeffe, Appajosula Sarada Rao, Henry Weresh, Eddie Blay, Chad T. Wilson, Ron Barbosa, Jordan M. Kirsch, Jeffry Nahmias, Zachary M. Bauman, Reynold Henry, Lewis E. Jacobson, Michael Goodman, Kaushik Mukherjee, Hiba Al-Dulaimi, Elliott Haut, Walter L. Biffl, David C. Evans, Claudia Alvarez, Frank C. Wood, Jin Ra, Jay Fickle, Bryan Collier, Lauren Craugh, Brennan Smith, Kevin Chow, Chun Yun Hsu, Pascal O. Udekwu, Jamie M. Williams
article en

Abstract

BackgroundThe purpose of this descriptive study was to characterize the utilization and outcomes of CPB after trauma.MethodsThis is an AAST-sponsored retrospective (2011-2021) multicenter (32 centers) study of all adult trauma patients undergoing CPB. Univariate analysis comparing demographics, clinical characteristics and the study outcomes were performed between those who required CPB≤2 hours, >2-24 hours, and >24 hours from the arrival. The primary outcome was mortality.ResultsThere were 113 patients, 63% sustained blunt trauma. The most common injuries were cardiac (42%), thoracic aorta (42%), and pericardial tamponade (25%). The three most common reasons to use CPB were aortic repair (32%), cardiopulmonary resuscitation (20%), and cardiac repair (15%). CPB was performed within 2 hours in 44(39%), and 21(19%) underwent CPB after 24-hours. Penetrating mechanisms of injury 24 (55%) (<i>P</i> = .009), higher rate of hypotension (SBP <80 mmHg) 15 (71%) (<i>P</i> = .002) were more common in CPB≤2-hours. Septal (<i>P</i> = .001) and valvular (<i>P</i> = .002) injuries were more frequent in CPB >24 hours, otherwise there were no differences in injury patterns among CPB ≤2 hours, >2-24 hours, and >24 hours. Cardiac repair was the most common indications for CPB ≤2 hours (<i>P</i> = .002), aorta repair was more common in CPB 2-24 hours (<i>P</i> = .03). Complications were not different between CPB ≤2 hours, >2-24 hours, and >24 hours. Among survivors, no differences in terms of discharge disposition, hospital LOS were found (all <i>P</i> > .05). Mortality was 22% with 96% of them undergoing CPB in the first 24 hours (<i>P</i> < .001).ConclusionsCPB is rarely used for traumatic injuries. The true impact of CPB is unknown and should be studied in comparison to patients with cardiovascular injuries that are repaired without CPB.Level of EvidenceLevel IV; Therapeutic/Care Management.

The American Surgeon
Tulane University (US), University of Maryland, Baltimore (US), Cedars-Sinai Medical Center (US), University of Kentucky HealthCare (US), Grant Medical Center (US), Tufts Medical Center (US), Loma Linda University Medical Center (US), Grady Memorial Hospital (US), Legacy Emanuel Medical Center (US), Nebraska Medical Center (US), Westchester Medical Center (US), NewYork–Presbyterian Hospital (US), Oregon Health & Science University (US), University of California, Irvine (US), Washington University in St. Louis (US), Cornell University (US), The University of Texas at Tyler (US), Loma Linda University (US), Ben Taub Hospital (US), Hadassah Medical Center (IL), Carilion Roanoke Memorial Hospital (US), New York Hospital Queens (US), Yale University (US), Augusta University Health (US), Presbyterian Hospital (US), University of California, Irvine Medical Center (US), St. Vincent Hospital (US), WakeMed (US), Ohio University (US), Scripps Clinic Medical Group (US), University of North Carolina Hospitals (US), University of Kansas Medical Center (US), Johns Hopkins Hospital (US), University of California Davis Medical Center (US), Southwestern Medical Center (US), University of Oklahoma Health Sciences Center (US), Carilion Clinic (US), University of Cincinnati (US), University at Buffalo, State University of New York (US), University of Missouri (US), University of Arkansas for Medical Sciences (US), The University of Texas at Austin (US), The University of Texas Southwestern Medical Center (US), University of Oklahoma (US), Vanderbilt University Medical Center (US), The University of Texas Health Science Center at Tyler (US), University of Cincinnati Medical Center (US)
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Trauma Management and Diagnosis
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