Wang Hua, Cen Zhongran, Liu Xingxing, Liu Zhanguo, Hou Xiaotong, Guan Xiangdong, Wu Jianfeng, Li Yimin, Xu Yonghao, Zhou Chengbin, Peng Zhiyong, Zhou Fachun, Sun Tongwen, Qin Bingyu, Lin Jiandong, Zhang Lina, Li Jinghui, Shang You, Liu Songqiao, Zeng Zhenhua, Wang Xiaowu, Chen Qunqing, Guo Yanwu, Peng Changbiao, Wang Yang, Li Songjian, Wang Chunyao, Xiang Shulin, Cheng Zhou, Cao Peihua, Jiang Jie, Chen Yihao, Yu Duoduo, Liao Wenzhan, Liao Ye, Cheng Xiaoqin, Chen Limei, He Yuxuan, He Jie, Guo Qingling, Yue Zenghui, Deng Ke, Tang Ying, Huang Bo, Liu Cuiping, Peng Sheng, Cai Jing, Zhu Yaru, Wang Kai, Wang Yangyang, Wang Qianwen, Yang Jingjing, Shichen Maoyou, Li Zhuo, Guo Manli, Luo Xueshan
Department of Critical Care Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
Department of Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Crit Care. 2025 Jul 29;29(1):334. doi: 10.1186/s13054-025-05504-6.
Adult trauma patients with refractory acute cardiopulmonary failure suffer from high morbidity and mortality. In the past decade, a growing body of researches has shown survival benefits of extracorporeal membrane oxygenation (ECMO) in trauma patients who fail to respond to optimal damage control resuscitation (DCR), and there is an opportunity to formulate clinical practice guidelines to guide clinicians in implementing trauma ECMO at the bedside.
The Chinese Society of Extracorporeal Life Support (CSECLS) convened a domestic panel of interdisciplinary experts to develop this guideline, adhering to the principles of the World Health Organization (WHO) Manual for Guideline Development and the policy of conflict of interest. Clinical key questions pertaining to trauma ECMO use were informed from expert interviews and literature reviews, and formulated as PICO (Population/Intervention/Comparison/Outcome) format for literature retrieval of original studies supporting the question. Then, panelists were assigned to address specific clinical questions, synthesize evidence, formulate recommendations and determine their strength, following the Recommendations Assessment, Development and Evaluation (GRADE) framework. The guideline steering committee and stakeholders approved the final document.
Eleven recommendations regarding trauma ECMO use in adult patients were formulated, focusing on the following topics: (1) indications; (2) patient screening; (3) timing of initiation; (4) multidisciplinary approach; (5) trauma ECMO management; and (6) complication prevention. Supporting evidences are elaborated in detail, and expert opinions on clinical application and future research provided.
Although the quality of the body of evidence is low to very-low, most researches have shown that ECMO improves the survival of adult trauma patients with varied injury mechanisms. However, decision-making should consider the individual characteristics, benefits and potential harms, patients' values and preferences, and long-term outcomes.
患有难治性急性心肺衰竭的成年创伤患者具有较高的发病率和死亡率。在过去十年中，越来越多的研究表明，体外膜肺氧合（ECMO）对未能对最佳损伤控制复苏（DCR）做出反应的创伤患者有生存益处，因此有机会制定临床实践指南，以指导临床医生在床边实施创伤ECMO。
中国体外生命支持学会（CSECLS）召集了一个国内跨学科专家小组来制定本指南，遵循世界卫生组织（WHO）《指南制定手册》的原则和利益冲突政策。通过专家访谈和文献综述确定了与创伤ECMO使用相关的临床关键问题，并将其表述为PICO（人群/干预措施/对照/结局）格式，以便对支持该问题的原始研究进行文献检索。然后，根据推荐意见评估、制定和评价（GRADE）框架，分配小组成员处理具体的临床问题、综合证据、制定建议并确定其强度。指南指导委员会和利益相关者批准了最终文件。
制定了11条关于成年患者创伤ECMO使用的建议，重点关注以下主题：（1）适应症；（2）患者筛查；（3）启动时机；（4）多学科方法；（5）创伤ECMO管理；（6）并发症预防。详细阐述了支持证据，并提供了关于临床应用和未来研究的专家意见。
尽管证据质量低至极低，但大多数研究表明，ECMO可提高具有不同损伤机制的成年创伤患者的生存率。然而，决策应考虑个体特征、益处和潜在危害、患者的价值观和偏好以及长期结局。
