Extracorporeal membrane oxygenation use in trauma and emergency care: An update

Extracorporeal membrane oxygenation (ECMO) has a life-saving role in trauma management, with particular relevance to patients with acute respiratory failure. This narrative review describes the current evidence on the use of ECMO in the resuscitation of major trauma victims presenting with acute respiratory distress syndrome, cardiogenic shock, poisoning, burns, and traumatic brain injury, and highlights recent advances in the field. A comprehensive literature search of PubMed and EMBASE was performed for articles, using the MeSH/keywords. Over the past decade, ECMO has been increasingly applied for trauma management, encompassing both venovenous (VV) and venoarterial (VA) modes. VV-ECMO is primarily utilized in hypoxic respiratory failure following thoracic trauma and is associated with improved in-hospital mortality and higher discharge survival compared to conventional mechanical ventilation. VA-ECMO is reserved for hemodynamic collapse and extracorporeal cardiopulmonary resuscitation, a subset of VA-ECMO used specifically in cardiac arrest. Despite promising outcomes, challenges remain, including anticoagulation management, hemorrhagic complications, and the absence of trauma-specific prognostic models. Emerging applications include ECMO in traumatic brain injury, poisoning, and severe burns. Although ECMO improves outcomes in selected trauma patients, further high-quality studies are needed to define optimal selection criteria and to clarify its role across the spectrum of injuries.