Current role of extracorporeal membrane oxygenation for the management of trauma patients: Indications and results

Abstract

Extracorporeal membrane oxygenation (ECMO) has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies. ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide. This blood is then reintroduced into the patient’s circulatory system. This process makes ECMO essential for treating various medical conditions, both as a standalone therapy and as adjuvant therapy. Veno-venous (VV) ECMO primarily supports respiratory function and indicates respiratory distress. Simultaneously, veno-arterial (VA) ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications. This study reviews recent literature to elucidate the evolving role of ECMO in trauma care, considering its procedural intricacies, indications, contraindications, and associated complications. Notably, the use of ECMO in trauma patients, particularly for acute respiratory distress syndrome and cardiogenic shock, has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury, bleeding, thrombosis, and hemolysis. Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation, whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO. ECMO plays a critical role in managing trauma patients, particularly those with acute respiratory failure. Further research is necessary to explore the full potential of ECMO in trauma care. Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.

Keywords: Extracorporeal membrane oxygenation treatments; Multiple trauma; Respiratory distress syndrome; Cardiogenic shock; Contraindications; Anticoagulants

Core Tip: Extracorporeal membrane oxygenation (ECMO), comprising veno-venous (VV) and veno-arterial (VA) modalities, offers crucial circulatory and respiratory support for trauma patients with severe cardiac or pulmonary conditions. VV ECMO is indicated for respiratory distress, including acute respiratory distress syndrome, whereas VA ECMO aids in cardiogenic shock and cardiac arrest. Anticoagulation poses challenges, particularly in trauma patients; however, tailored approaches mitigate the risks. Complications such as acute kidney injury and bleeding highlight the need for vigilant monitoring. Standardized protocols and ongoing research are pivotal for optimizing ECMO utilization and outcomes in trauma care, warranting multidisciplinary collaboration and individualized patient management.