ECMO-facilitated adult non-cardiac surgery: a structured narrative review

Extracorporeal membrane oxygenation (ECMO) has traditionally been used as rescue support for severe respiratory failure, cardiopulmonary failure, or perioperative cardiac surgical care, but its expanding perioperative role has enabled selected non-cardiac operations in patients otherwise considered too unstable for surgery. We performed a structured narrative review of reported ECMO-assisted adult non-cardiac surgery, focusing on airway, trauma, burn, vascular, and obstetric applications. Published case reports, case series, retrospective cohorts, database analyses, and relevant reviews were identified through structured searches of PubMed/MEDLINE, PubMed Central, and Google Scholar, supplemented by manual reference review. For this review, ECMO-assisted surgery included both planned or enabling ECMO initiated specifically to permit an operation and ECMO-supported surgery performed while a patient was already receiving ECMO for respiratory or circulatory failure. Airway and tracheobronchial surgery represented the most developed application, whereas trauma, burn, vascular, and obstetric reports more commonly described ECMO as rescue or stabilizing support that permitted necessary surgery to proceed. Across specialties, the published experience demonstrates technical feasibility in highly selected reported patients but is dominated by case reports and small observational series, with substantial publication and selection bias and few comparator populations. Multidisciplinary planning, individualized cannulation and anticoagulation strategies, hemorrhage preparedness, anesthetic planning, and postoperative critical care are central to safe implementation. The current literature should not be interpreted as establishing a survival or treatment-effectiveness benefit.