Challenges of ECMO use for severe trauma: a narrative review

BACKGROUND: Patients with severe trauma are at high risk of developing life-threatening complications, including acute respiratory failure and circulatory collapse. Extracorporeal membrane oxygenation (ECMO) offers critical support when conventional therapies fail. This narrative review aimed to analyze the clinical application of ECMO in patients with severe trauma, focusing on indications, complications, prognostic factors, and future directions. METHODS: A comprehensive literature search was conducted to identify studies published between January 2000 and April 2025. Sources included original research articles, systematic reviews, and meta-analyses, supplemented by relevant clinical guidelines and expert consensus statements pertaining to ECMO use in trauma care. RESULTS: Veno-venous ECMO has been primarily utilized in patients with trauma-associated acute respiratory distress syndrome, while veno-arterial ECMO has been employed in the management of cardiogenic shock and cardiac arrest. Reported survival rates were 72.3% for veno-venous ECMO and 39.0% for veno-arterial ECMO. ECMO has also been used in patients with traumatic brain injury and those undergoing extracorporeal cardiopulmonary resuscitation, although randomized controlled trial data remain limited Major complications include infection, hemorrhage, and thrombosis, which require coordinated prevention and management strategies. Prognostic tools such as the New Injury Severity Score, Simplified Acute Physiology Score III, and Sequential Organ Failure Assessment score are used in clinical evaluation, though trauma-specific models are still lacking. CONCLUSION: ECMO offers a supportive treatment modality in the management of patients with severe trauma. To improve clinical outcomes, further development of trauma-specific decision tools, multicenter studies, and standardized protocols for anticoagulation and infection control is necessary to support individualized care.