Extracorporeal Membrane Oxygenation (ECMO) in Trauma Patients

Silvia Mariani, Anne Willers, Roberto Fumagalli, Fabio Sangalli*

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterAcademic

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.
Original languageEnglish
Title of host publicationThe High-Risk Surgical Patient
EditorsPaolo Aseni, Antonino Massimiliano Grande, Ari Leppäniemi, Osvaldo Chiara
PublisherSpringer International Publishing
Pages947-955
Number of pages9
ISBN (Electronic)9783031172731
ISBN (Print)9783031172724
DOIs
Publication statusPublished - 1 Jan 2023

Keywords

  • Acute respiratory distress syndrome
  • Burns
  • Cardiac trauma
  • Chest trauma
  • Combat casualties
  • Drowning
  • ECLS
  • ECMO
  • Extracorporeal life support
  • Extracorporeal membrane oxygenation
  • Hemorrhage
  • Hypothermia
  • Trauma
  • Traumatic brain injury
  • Traumatic cardiac arrest

Fingerprint

Dive into the research topics of 'Extracorporeal Membrane Oxygenation (ECMO) in Trauma Patients'. Together they form a unique fingerprint.

Cite this