Extracorporeal Membrane Oxygenation (ECMO) in Trauma Patients

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.