ECMO Cannulation for Cardiac and Hemodynamic Support in Trauma

Purpose of Review Extracorporeal membrane oxygenation (ECMO) represents an increasingly utilized rescue therapy for critically ill patients. Despite increasing literature supporting its use for cardiac, pulmonary, and combined cardiopulmonary failure, its role in acute trauma remains ill-defined. Recent Findings Venovenous and venoarterial ECMO have demonstrated utility following acute respiratory distress syndrome (ARDS) and cardiac arrest and as a temporary bridge to transplantation. Venovenous ECMO for trauma patients with ARDS appears safe and may offer mortality benefits when performed early, although more robust data is needed. The data surrounding venoarterial ECMO following traumatic arrest or for devastating cardiopulmonary injuries is limited to small case series and low-quality evidence. Summary ECMO cannulation for cardiac and hemodynamic support in trauma patients is limited to low-quality data. Early cannulation in select cases, however, may provide an opportunity to help correct physiologic parameters, maintain perfusion, and temporize various injury patterns prior to surgical repair. Following traumatic arrest, venoarterial ECMO may help improve hemodynamics and augment hemorrhage control; however, more robust data is needed.