Key result
ECMO provides viable trauma support and can often be managed without systemic anticoagulation.
Why the study?
Extracorporeal membrane oxygenation (ECMO) use in adult, pediatric, and combat trauma patients has increased significantly over the past 10 years.
This review emphasizes that ECMO is a viable and potentially life-saving intervention for trauma patients with severe respiratory or cardiac failure, and that traumatic injury or brain injury is no longer an absolute contraindication given modern anticoagulation-free ECMO strategies.
May support ECMO in select trauma patients without anticoagulation; leaves open need for prospective trials before practice change.
Over the past 10 years, extracorporeal membrane oxygenation (ECMO) use in trauma patients has increased significantly. This includes adult and pediatric trauma patients and even combat casualties. Most ECMO applications are in a venovenous (VV ECMO) configuration for acute hypoxemic respiratory failure or anatomic injuries that require pneumonectomy or extreme lung rest in a patient with insufficient respiratory reserve. In this narrative review, we summarize the most common indications for VV ECMO and other forms of ECMO support used in critically injured patients, underscore the importance of early ECMO consultation or regional referral, review the technical aspects of ECMO cannulation and management, and examine the expected outcomes for these patients. In addition, we evaluate the data where it exists to try to debunk some common myths surrounding ECMO management.
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Flatley et al. (2023) conducted a review in Critically injured trauma patients with refractory respiratory failure or cardiogenic shock. Extracorporeal membrane oxygenation (ECMO) was evaluated. Extracorporeal membrane oxygenation is an increasingly utilized, viable support strategy for adult and pediatric trauma patients that can often be managed without systemic anticoagulation.
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