Extracorporeal Membrane Oxygenation (ECMO) in Trauma

  • Antonino M. GrandeEmail author
  • Antonella Degani
  • Antonio Fiore
  • Paolo Aseni


Patients with traumas and associated cardiopulmonary failure have a high mortality rate; in such patients, the use of extracorporeal membrane oxygenation (ECMO) may grant patient’s tissue perfusion supporting cardiac and respiratory functions in traumatic lung injuries who do not respond to conventional mechanical ventilation and other treatments: chemical paralysis, prone positioning, inhaled prostacyclins, and pressure-controlled inverse ratio ventilation. When all these treatment provisions are not adequate, and lung compliance becomes worse, the increased inspiratory pressures may cause barotrauma and further impaired lung function. Nevertheless, trauma patients may present acute heart failure, e.g., due to a serious bleeding, stunned heart following direct trauma (severe contusion and hematoma), or depression determined by acidosis and hypothermia. The clinical use of ECMO, providing a bridge to rescue therapy, is becoming increasingly frequent showing a dramatic improvement in survival rate or allowing organ donation after cardiac death.


ECMO Pump Oxygenator Single lumen cannula Dual lumen cannula Trauma Respiratory failure Cardiogenic shock 


  1. 1.
    Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD. Epidemiology of trauma deaths. Am J Surg. 1980;140:144–50.CrossRefGoogle Scholar
  2. 2.
    Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am. 1983;249:28–35.CrossRefGoogle Scholar
  3. 3.
    Sobrino J, Shafi S. Timing and causes of death after injuries. Proc (Bayl Univ Med Cent). 2013;26:120–3.CrossRefGoogle Scholar
  4. 4.
    Barton RG, Craft WB, Mone MC, Saffle JR. Chemical paralysis reduces energy expenditure in patients with burns and severe respiratory failure treated with mechanical ventilation. J Burn Care Rehabil. 1997;18:455–60.CrossRefGoogle Scholar
  5. 5.
    Ahmad SB, Menaker J, Kufera J, O’Connor J, Scalea TM, Stein DM. Extracorporeal membrane oxygenation after traumatic injury. J Trauma Acute Care Surg. 2017;82:587–91.CrossRefGoogle Scholar
  6. 6.
    Garlick J, Maxson T, Imamura M, Green J, Prodhan P. Differential lung ventilation and venovenous extracorporeal membrane oxygenation for traumatic bronchopleural fistula. Ann Thorac Surg. 2013;96:1859–60.CrossRefGoogle Scholar
  7. 7.
    Pierson DJ, Horton CA, Bates PW. Persistent bronchopleural air leak during mechanical ventilation. A review of 39 cases. Chest J. 1986;90:321–3.CrossRefGoogle Scholar
  8. 8.
    Dreizin D. Extracorporeal membrane oxygenation in plytrauma : what the radiologist needs to know. Emerg Radiol. 2015;22:565–76.CrossRefGoogle Scholar
  9. 9.
    Enomoto Y, Watanabe H, Nakao S, Matsuoka T. Complete thoracic tracheal transection caused by blunt trauma. J Trauma Acute Care Surg. 2011;71:1478.CrossRefGoogle Scholar
  10. 10.
    Daoud O, Augustin P, Mordant P, et al. Extracorporeal membrane oxygenation in 5 patients with bronchial fistula with severe acute lung injury. Ann Thorac Surg. 2011;92:327–30.CrossRefGoogle Scholar
  11. 11.
    Sian K, McAllister B, Brady P. The use of extracorporeal membrane oxygenation therapy in the delayed surgical repair of a tracheal injury. Ann Thorac Surg. 2014;97:338–40.CrossRefGoogle Scholar
  12. 12.
    Brogan TV, Lequier L, Lorusso R, MacLaren G, Peek G. Extracorporeal life support: the ELSO Red Book. 5th ed: Red Book; 2017. p. 61.Google Scholar
  13. 13.
    Yu K, Long C, Hei F, Li J, Liu J, Ji B, et al. Clinical evaluation of two different extracorporeal membrane oxygenation systems: a single center report. Artif Organs. 2011;7:733–7.CrossRefGoogle Scholar
  14. 14.
    McMullan DM, Emmert JA, Permut LC, et al. The inflammatory and coagulative response to prolonged extracorporeal membrane oxygenation. Eur J Cardiothorac Surg. 2011;39:392–7.CrossRefGoogle Scholar
  15. 15.
    Hill JG, Bruhn PS, Cohen SE, Gallagher MW, Manart F, Moore CA, Seifert PE, Askari P, Banchieri C. Emergent applications of cardiopulmonary support: a multiinstitutional experience. Ann Thorac Surg. 1992;54:699–704.CrossRefGoogle Scholar
  16. 16.
    Lequier L, Horton SB, McMulla DM, Bartlett RH. Extracorporeal membrane oxygenation circuitry. Pediatr Crit Care Med. 2013;14:S7–12.CrossRefGoogle Scholar
  17. 17.
    Hirose H, Yamane K, Marhefka G, Cavarocchi N. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation. J Cardiothorac Surg. 2012;7:36. Scholar
  18. 18.
    Brogan TV, Lequier L, Lorusso R, MacLaren G, Peek G. Extracorporeal life support: the ELSO Red Book. 5th ed. Red Book;2017. p. 69.Google Scholar
  19. 19.
    Reeb J, Olland A, Renaud S, Lejay A, Massard G, Falcoz P-E. Vascular access for extracorporeal life support: tips and tricks. J Thorac Dis. 2016;8:S353–63.CrossRefGoogle Scholar
  20. 20.
    Chen TH, Shih JY, Shih JJ. Early percutaneous heparin-free veno-venous extra corporeal life support (ECLS) is a safe and effective means of salvaging hypoxemic patients with complicated chest trauma. Acta Cardiol Sin. 2016;32:96–102.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Arlt M, Philipp A, Voelkel S, Rupprecht L, Mueller T, Hilker M, Graf B, Schmid C. Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock. Resuscitation. 2010;81:804–9.CrossRefGoogle Scholar
  22. 22.
    Bonacchi M, Spina R, Torracchi L, harmelin G, Sani G, Peris A. Extracorporeal life support in patients with severe trauma: an advanced treatment strategy for refractory clinical settings. J Thorac Cardiovasc Surg. 2013;145:1617–26.CrossRefGoogle Scholar
  23. 23.
    Ried M, Bein T, Philipp A, Müller T, Graf B, Schmid C, Zonies D, Diez C, Hofmann HS. Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. Crit Care. 2013;17(3):R110.CrossRefGoogle Scholar
  24. 24.
    Madershahian N, Wittwer T, Strauch J, Franke UF, Wippermann J, Kaluza M, Wahlers T. Application of ECMO in multitrauma patients with ARDS as rescue therapy. J Card Surg. 2007;22:180–4.CrossRefGoogle Scholar
  25. 25.
    Guirand DM, Okoye OT, Schmidt BS, Mansfield NJ, Aden JK, Martin RS, Cestero RF, Hines MH, Pranikoff T, Inaba K, et al. Venovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure: a multicenter retrospective cohort study. J Trauma Acute Care Surg. 2014;76(5):1275–81.CrossRefGoogle Scholar
  26. 26.
    Schupp M, Swanedelder JL, Peek GJ, Sonoswxki AW, Spyt TJ. Postoperative extracorporeal membrane oxygenation for severe intraoperative SRS 10 h after multiple trauma. Br J Anaesth. 2003;90:91–4.CrossRefGoogle Scholar
  27. 27.
    Masiakos PT, Hirsch EF, Millham FH. Management of severe combined pulmonary and myocardial contusion with extracorporeal membrane oxygenation. J Trauma. 2003;54:1012–5.CrossRefGoogle Scholar
  28. 28.
    Michaels AJ, Schriener RJ, Kolla S, Awad SS, Rich PB, Reickert CR, Ypunger J, Hirschl RB, Bartlett RH. Extracorporeal life support in pulmonary failure after trauma. J Trauma. 1999;46:638–45.CrossRefGoogle Scholar
  29. 29.
    Perchinsky MJ, Long WB, Hill JG, Parson JA, Bennet JB. Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients. Am J Surg. 1995;168:488–91.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Antonino M. Grande
    • 1
    Email author
  • Antonella Degani
    • 1
  • Antonio Fiore
    • 2
  • Paolo Aseni
    • 3
  1. 1.Department of Cardiac SurgeryIRCCS Fondazione Policlinico San MatteoPaviaItaly
  2. 2.Department of Cardiothoracic SurgeryHenri Mondor University Hospital, AP-HP, Paris-Est UniversityCréteilFrance
  3. 3.Dipartimento di Emergenza UrgenzaASST Grande Ospedale Metropolitano NiguardaMilanoItaly

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