Management of burn patients undergoing surgery while on extracorporeal membrane oxygenation (ECMO): clinical experience and a standardized perioperative protocol

Abstract Severe burn injuries complicated by acute respiratory failure present unique challenges in critical care medicine. Although the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) can offer life-saving support for this patient cohort, the perioperative management of burn patients on ECMO remains poorly standardized, and evidence-based guidelines are lacking. This perspective outlines the experiences gained from managing burn patients undergoing surgery while on V-V ECMO at a major burn center. Over a 3-year period, 14 patients with an average burned total body surface area (TBSA) involvement of 41% were treated with ECMO support. Several key strategies contributed to the safe surgical management of these patients. Looking ahead, there is a clear need for multicenter registry data and collaborative efforts to establish standardized perioperative protocols for burn patients receiving ECMO. Individualized anticoagulation management using point-of-care techniques such as thromboelastography, and the evaluation of optimal surgical timing strategies, will be essential areas for future research. In conclusion, interdisciplinary teamwork and structured perioperative management protocols can enable safe surgical treatment of burn patients on ECMO. Broader collaboration and standardized data collection are crucial steps to improving outcomes and establishing best practices for this complex patient population.