ECLS in Trauma: Practical Application and a Review of Current Status

Area of Science:

• Critical Care Medicine
• Cardiovascular Surgery
• Respiratory Medicine

Background:

• Extracorporeal life support (ECL) has advanced significantly in the last 20 years.
• Extracorporeal membrane oxygenation (ECMO) is transitioning from experimental to standard therapy for adult critical care.
• Traditionally, trauma and high-risk surgical patients were excluded from ECMO consideration.

Purpose of the Study:

• To highlight the evolution of ECMO in adult critical care.
• To discuss technological advancements enabling broader ECMO application.
• To advocate for early ECMO consideration in specific patient populations.

Main Methods:

• Review of technological advancements in ECMO.
• Analysis of ECMO's expanding role in critical care.
• Discussion of ECMO application in severe acute respiratory distress syndrome (ARDS) and cardiogenic shock.
• Consideration of ECMO for trauma and surgical patients with severe ARDS.

Main Results:

• Technological progress includes anticoagulant-bonded circuits, miniaturization, servo-regulated systems, and improved oxygenators.
• ECMO is now rapidly deployable for severe ARDS and cardiogenic shock in adults.
• ECMO offers a viable treatment option for previously excluded patient groups.

Conclusions:

• ECMO is evolving into a mainstream treatment for adult critical care.
• Advancements facilitate ECMO use in trauma and high-risk surgical patients.
• Early ECMO consideration is recommended for trauma/surgical patients with severe ARDS for optimal lung rest.