ID:49 FC-D11-9 Emerging Indications for ECMO in Severe Trauma: A Single-Center Experience

Background: Although ECMO has been reported to be effective in severe trauma, its indications remain controversial; therefore, we reviewed our single-center experience to explore potential new indications. Methods: We retrospectively reviewed trauma cases managed with ECMO between 2019 and 2025, focusing on indications, management strategies, and outcomes. Results: Eight patients were included. VA ECMO was used in two patients with cardiac rupture and one patient with refractory shock after transcatheter arterial embolization for pelvic fracture. The VV ECMO cases comprised four patients with blunt thoracic trauma and one patient with ARDS following abdominal trauma. In the VA ECMO case for blunt right ventricular rupture, ECMO was instituted to provide circulatory support and right-sided cardiac decompression during surgical repair following resuscitative thoracotomy, and the patient was discharged alive. All VV ECMO cases for thoracic trauma involved young patients with blunt injury; ECMO was initiated within 7 days for respiratory failure due to pulmonary contusion and hemopneumothorax, and three survived to discharge. One patient developed organized tracheobronchial thrombi, which were removed under ECMO-assisted airway and respiratory management. Conclusions: VA ECMO for intraoperative circulatory support and right-sided cardiac decompression during repair of right ventricular rupture, and VV ECMO as an adjunct to airway and respiratory management for acute-phase respiratory failure due to thoracic trauma–including cases with organized tracheobronchial thrombi–may expand current ECMO indications in severe trauma.