We aimed to evaluate the outcomes of post‑traumatic acute respiratory distress syndrome (ARDS)in young patients with and without Extracorporeal membrane oxygenation (ECMO) support. A retrospective analysis was conducted for trauma patients who developed ARDS at a level I traumafacility between 2014 and 2020. Data were analyzed and compared between ECMO and non‑ECMOgroup. We identified 85 patients with ARDS (22 patients had ECMO support and 63 matched patientsmanaged by the conventional mechanical ventilation; 1:3 matching ratio). The two groups werecomparable for age, sex, injury severity score, abbreviated injury score, shock index, SOFA score,and head injury. Kaplan Meier survival analysis showed that the survival in the ECMO group wasinitially close to that of the non‑ECMO, however, during follow‑up, the survival rate was better in theECMO group, but did not reach statistical significance (Log‑rank, p = 0.43 and Tarone‑Ware, p = 0.37).Multivariable logistic regression analysis showed that acute kidney injury (AKI) (Odds ratio 13.03; 95%CI 3.17–53.54) and brain edema (Odds ratio 4.80; 95% CI 1.10–21.03) were independent predictors ofmortality. Sub‑analysis showed that in patients with severe Murray Lung Injury (MLI) scores, non‑ECMO group had higher mortality than the ECMO group (100% vs 36.8%, p = 0.004). Although ARDS isuncommon in young trauma patients, it has a high mortality. ECMO therapy was used in a quarter ofARDS cases. AKI and brain edema were the predictors of mortality among ARDS patients. ECMO usedid not worsen the outcome in trauma patients; however, the survival was better in those who hadsevere MLI and ECMO support. Further prospective study is needed to define the appropriate selectioncriteria for the use of ECMO to optimize the outcomes in trauma patients.

Trauma is the frequent cause of mortality in severely injured young patients secondary to hemorrhagic shock and cardiopulmonary dysfunction. Therefore, controlling active bleeding and maintaining arterial oxygenation are essential to improve the patients’ outcome 1,2 . Around 10–20% of polytrauma patients may develop severe respiratory complications which necessitate ventilatory support3,4 . Among such patients, acute respiratory distress syndrome (ARDS) remains a challenging complication which may occur in 6.5% of patients requiring mechanical ventilation for greater than 48 h 5 . Notably, ARDS is multifactorial that could be related to direct thoracic trauma and/or indirect injury caused by extrapulmonary trauma and its management such as massive transfusion, fluid overload, and ventilator-induced acute lung injury 6 . Despite advances in pulmonary critical care management with adoption of lung protective ventilation, the mortality rate remains high among trauma patients with ARDS (17–46%) 7–9 . For instance, it is challenging to apply adjunctive measures such as prone positioning with conventional ventilator management strategies for ARDS in patients with brain, spine, or pelvic injuries. Moreover, permissive hypercapnia may be difficult to effectively manage ARDS in patients with traumatic brain injury 9,10 . Extracorporeal membrane oxygenation (ECMO) has been used as a salvage therapy in patients with unsuc- cessful or unsatisfactory conventional ventilatory support. It is effective in treating hypoxic respiratory failure caused by traumatic lung injury. This may be related to the benefit of warming, correction of acidosis, better oxygenation, and circulatory support 11 . Some studies have reported survival rates between 50–79% after the utilization of ECMO in trauma 12–15 . Although, the use of ECMO in non-trauma setting continues to expand, its utility in trauma patients remains controversial or inaccessible in many centers. Limited resources, bleeding, thrombosis, limb ischemia, traumatic brain injury, complicated pelvic fractures, major vascular injuries, and lack of technical expertise are the major factors affecting the widespread use of ECMO in trauma patients 16 . The use of ECMO in trauma patients is recently adopted in selected cases in our trauma center at Hamad Medical Corporation (HMC). To date, data on the use of ECMO in trauma patients are underreported in our region in the Arab Middle East. The present study aims to evaluate the outcomes of post-traumatic ARDS in young patients with and without the use of ECMO in a level-1 trauma center and to look for the role of acute kidney injury (AKI) in those patients as well. We hypothesized that the use of ECMO in trauma patients with ARDS is associated with better outcomes.