Extracorporeal membrane oxygenation for acute respiratory distress syndrome in trauma patients: a case series and systematic literature review.

Background: Veno-venous extra-corporeal membrane oxygenation (vv-ECMO) is an established salvage therapy for severe respiratory failure, and may provide an alternative form of treatment for trauma-induced acute respiratory distress syndrome (ARDS) when conventional treatments have failed. The need for systemic anticoagulation is a relative contraindication in patients with bleeding risks, especially in multi traumatic injury. Methods: We describe a case series of four trauma patients with ARDS who were managed with ECMO admitted to the Neuro Critical Care Unit (NCCU) at Addenbrooke's Hospital, Cambridge (UK), from January 2000 to January 2016. We performed a systematic review of the available literature in order to investigate the safety and efficacy of vv-ECMO in post-traumatic ARDS focusing on the use of different anticoagulation strategies and risk of bleeding in polytrauma patients. Results: Thirty-one patients were included. A heparin bolus was given in 16 cases. Eleven patients developed complications during treatment with ECMO with 3 cases of major bleeding. In all documented cases of bleeding a bolus and infusion of heparin was administered, aiming for an ACT target > 150 s. Two patients treated with heparin-free ECMO developed thromboembolic complications. Four patients died and death was never directly or indirectly related to use of ECMO. Conclusions: Vv-ECMO can be lifesaving in respiratory failure. Our experience and our literature review suggests that vv-ECMO should be considered as rescue treatment for the management of severe hypoxemic respiratory failure secondary to ARDS in trauma patients. In patients with a high risk of bleeding, the use of ECMO with no initial anticoagulation could be considered a valid option. In patients with a moderate risk of bleeding, use of a heparin infusion keeping an ACT target

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