Abdulrahman Mohammed, Makki Maryam, Bentaleb Malak, Altamimi Dana Khamis, Ribeiro Junior Marcelo Af
Department of Surgery, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi 11001, United Arab Emirates.
Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Abu Dhabi 11001, United Arab Emirates.
World J Crit Care Med. 2025 Mar 9;14(1):96694. doi: 10.5492/wjccm.v14.i1.96694.
Extracorporeal membrane oxygenation (ECMO) has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies. ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide. This blood is then reintroduced into the patient's circulatory system. This process makes ECMO essential for treating various medical conditions, both as a standalone therapy and as adjuvant therapy. Veno-venous (VV) ECMO primarily supports respiratory function and indicates respiratory distress. Simultaneously, veno-arterial (VA) ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications. This study reviews recent literature to elucidate the evolving role of ECMO in trauma care, considering its procedural intricacies, indications, contraindications, and associated complications. Notably, the use of ECMO in trauma patients, particularly for acute respiratory distress syndrome and cardiogenic shock, has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury, bleeding, thrombosis, and hemolysis. Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation, whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO. ECMO plays a critical role in managing trauma patients, particularly those with acute respiratory failure. Further research is necessary to explore the full potential of ECMO in trauma care. Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.
体外膜肺氧合（ECMO）已成为对传统疗法无反应的严重心脏或肺部疾病患者至关重要的循环生命支持措施。ECMO允许从患者体内抽取血液并引入一台对血液进行氧合并去除二氧化碳的机器。然后将这种血液重新引入患者的循环系统。这一过程使得ECMO对于治疗各种医疗状况至关重要，既可以作为独立疗法，也可以作为辅助疗法。静脉 - 静脉（VV）ECMO主要支持呼吸功能，提示呼吸窘迫。同时，静脉 - 动脉（VA）ECMO提供血流动力学和呼吸支持，适用于心脏相关并发症。本研究回顾近期文献，以阐明ECMO在创伤护理中不断演变的作用，考虑其操作复杂性、适应证、禁忌证及相关并发症。值得注意的是，尽管存在抗凝管理等挑战以及急性肾损伤、出血、血栓形成和溶血等并发症，但ECMO在创伤患者中的应用，尤其是用于急性呼吸窘迫综合征和心源性休克时，已显示出有前景的结果。一些研究表明，VV ECMO与显著高于传统机械通气的生存率相关，而其他研究报告称VA ECMO与低于VV ECMO的生存率相关。ECMO在管理创伤患者，特别是急性呼吸衰竭患者方面发挥着关键作用。有必要进行进一步研究以探索ECMO在创伤护理中的全部潜力。临床医生应清楚了解使用ECMO的适应证和禁忌证，以最大限度地提高其在治疗创伤患者中的益处。
