ID:131 FC-D10-5 Heparin-Free VV-ECMO as a Damage Control strategy in Severe Multi-trauma with Refractory Hypoxemia

Background: The use of VV-ECMO in polytrauma patients remains controversial due to high bleedingrisk, especially in the early phase of trauma. Indication for VV-ECMO strategy in this setting is unclear. Clinical Course/ Activities: A 54-year-old woman sustained severe blunt multi-trauma including traumatic thoracic aorticinjury, multiple rib fractures with hemopneumothorax, pulmonary contusions, an unstableL1 burst fracture, pelvic ring fracture, and proximal humeral fracture. We admitted this patient tothe Hybrid Emergency Room System(HERS). Emergent thoracic endovascular aortic repair(TEVAR) was performed in the HERS. Shortly after the procedure, profound hypoxemiadeveloped (SpO2 50–60% despite manual ventilation). Hypoxemia was suspected to becaused by TACO or TRALI associated with massive transfusion. Rescue VV-ECMO wasimmediately initiated in the HERS without patient transfer. Configuration was femoro-femoral VV-ECMO. ECMO flow was maintained at 3.0 L/min (body weight 37 kg). Given the extremebleeding risk after TEVAR, anticoagulation was withheld and sufficient ECMO flow wasmaintained to prevent thrombus formation in the ECMO circuit. ECMO was successfullyweaned off after 3 days without bleeding and thrombosis (including in the ECMO circuit)complications. Subsequent definitive orthopedic surgeries were performed. The patientsurvived and was transferred from the ICU to a general ward without any significant events. Discussion: Reports of using VV-ECMO as damage control during the resuscitation phase of severe trauma are scarce. In such cases, ECMO is generally undesirable due to its potential to exacerbate bleeding. When the risk of hemorrhage outweighs the risk of thrombosis, VV-ECMO without systemic anticoagulation may be a justifiable. In this case, we were able to safely perform VV-ECMO without anticoagulation for bleeding prevention by maintaining sufficient ECMO flow for thrombosis prevention. Conclusion: Early and short-term heparin-free VV-ECMO may serve as a safe and effective damagecontrol strategy in selected multi-trauma patients with life-threatening hypoxemia.