Extracorporeal cardiopulmonary resuscitation and veno-arterial ECMO in trauma

Extracorporeal cardiopulmonary resuscitation (ECPR) shows promise for the emergency care of trauma patients in cardiac arrest but is not a part of current trauma resuscitation guidelines. The recognition of new management patterns in the critical management of trauma is needed as well as justification of whether wider use of extracorporeal resuscitation of trauma is warranted. VA ECMO (veno-arterial extracorporeal membrane oxygenation) support is well described in penetrating and blunt trauma, and the most common indications are hemodynamic instability, shock, cardiopulmonary failure, post-traumatic cardiac arrest, stabilization for damage control intervention, and diagnosed or suspected intrathoracic injuries. Trauma patients in extremis may benefit from extracorporeal life support (ECLS) for hemodynamic stabilization and perfusion restoration. The ECPR provides more time for additional assessment or transition to the operating room enabling better surgical exposure in more secure environment for the patient and as a bridge to definitive treatment. The weaning from VA ECMO and following decannulation often happens shortly after surgical intervention. There is potential to consider a new exrtacorporeal resuscitative algorithm for trauma patients.