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Extracorporeal Membrane Oxygenation (ECMO) in Trauma Patients

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Abstract

Although the first successful use of extracorporeal life support (ECLS) in adults was reported in post-traumatic respiratory failure, trauma has been traditionally considered a relative contraindication to ECLS due to the possible complications. In recent years, however, technological improvement and a better pathophysiological understanding led to increased use of ECLS in selected patients. Indeed, most uncertainties were related to hemorrhagic and thrombotic complications and were overcome with newer materials that allow for the initiation of support without anticoagulation when hemorrhagic risk is high.

The main indications for ECLS in trauma are represented by acute respiratory distress syndrome (ARDS) and chest trauma, including cardiac trauma and traumatic cardiac arrest, cerebral trauma and bleeding, hemorrhage, hypothermia, and burns in both adults and children. Specific scenarios including combat casualties are emerging indications as well.

Extracorporeal support can interrupt the vicious circle represented by the lethal triad of trauma (hypothermia, acidosis, and coagulopathy) by controlling temperature, providing an adequate cardiac output, and unloading the venous system. This can lead, according to registry data, to survival rates of around 60% in thoracic trauma patients supported with ECLS.

In this chapter, we will discuss the rationale and indications of ECLS in trauma and present some challenges for the application in this setting.

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Authors and Affiliations

  1. Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands

    Silvia Mariani & Anne Willers

  2. Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands

    Anne Willers

  3. Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Roberto Fumagalli

  4. School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    Roberto Fumagalli & Fabio Sangalli

  5. Department of Anesthesia and Intensive Care, ASST Valtellina e Alto Lario, Sondrio, Italy

    Fabio Sangalli

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  1. Silvia Mariani
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Correspondence to Fabio Sangalli .

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Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

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Mariani, S., Willers, A., Fumagalli, R., Sangalli, F. (2023). Extracorporeal Membrane Oxygenation (ECMO) in Trauma Patients. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_81

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