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Enhancing the detection of ECMO-related morphological changes: a post-mortem observational study and systematic
Andrea Scatena1, Julia Lazzari1, Pietro Bertini2
1Inst. of Legal Medicine, Dept. of Surgical Pathology, Medical, Molecular, and Critical Area, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
Legal Medicine (Tokyo, Japan)
|September 19, 2025
Summary
Extracorporeal Membrane Oxygenation (ECMO) can alter post-mortem findings, complicating forensic autopsies. A proposed pre-treatment examination aims to improve accuracy in forensic cases involving ECMO patients.
Area of Science:
- Intensive Care Medicine
- Forensic Pathology
- Cardiorespiratory Support
Background:
- Extracorporeal Membrane Oxygenation (ECMO) is a vital life-support system for severe cardiorespiratory failure unresponsive to standard treatments.
- ECMO is complex, requiring multidisciplinary expertise and knowledge of its indications, contraindications, complications, and limitations.
- ECMO use poses challenges for forensic medicine due to physiological changes that can create discrepancies in diagnoses.
Purpose of the Study:
- To review existing literature and case studies of patients who died after ECMO treatment.
- To illustrate post-mortem changes associated with ECMO and their impact on forensic interpretation.
- To propose a method for documenting pre-ECMO clinical status in forensic cases.
Main Methods:
- A systematic review of literature was conducted.
- Eight case studies of patients who died after ECMO treatment were analyzed.
- Forensic autopsies were performed on these cases.
- A procedure for pre-treatment external examination was developed.
Main Results:
- ECMO can induce physiological changes that complicate post-mortem diagnosis.
- Understanding these ECMO-related changes is crucial for accurate forensic conclusions.
- Case studies highlighted discrepancies between pre-mortem and post-mortem findings.
Conclusions:
- ECMO necessitates careful consideration in forensic autopsies due to potential post-mortem alterations.
- A standardized external examination before or early in ECMO treatment is proposed.
- This documentation aims to enhance the accuracy of forensic analysis in ECMO cases.
