Calm before the storm - austere environments - challenging indications (trauma)

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Cardiopulmonary Support

Background:

• Extracorporeal membrane oxygenation (ECMO) use is expanding in critically injured trauma patients requiring surgery.
• Advances in technology, cannulation, and anticoagulation have facilitated this growth.
• Trauma patients represent a small but growing proportion of overall ECMO utilization.

Purpose of the Study:

• To review the perioperative applications of ECMO in operative trauma management.
• To examine ECMO's role in preoperative, intraoperative, and postoperative phases.
• To identify current evidence and future research needs for ECMO in trauma surgery.

Main Methods:

• Literature review of ECMO applications in operative trauma.
• Analysis of ECMO use across different surgical phases (preoperative, intraoperative, postoperative).
• Synthesis of evidence regarding ECMO's impact on patient stabilization and outcomes.

Main Results:

• Preoperatively, ECMO addresses refractory hypoxemia/acidosis and aids transport.
• Intraoperatively, ECMO supports high-risk procedures and hemodynamic stability.
• Postoperatively, ECMO manages delayed respiratory failure, facilitating lung-protective ventilation.

Conclusions:

• ECMO is a valuable adjunct for stabilizing operative trauma patients.
• Evidence for ECMO in traumatic respiratory failure is growing, but data for other indications are limited.
• Prospective multicenter studies are essential to optimize ECMO use in trauma surgery.