Extracorporeal Membrane Oxygenation (ECMO) in Trauma

Key Points • Do not hesitate to use ECMO when respiratory and circulatory parameters are irreversibly worsened. • Use a circuit as short as possible; the relationship between resistance and circuit length is directly proportional: flow resistance within the circuit increases when the circuit is longer. Moreover, longer circuit lengths have a greater contact surface for flowing blood inside it, a greater need for priming solution, and greater heat loss. The circuit should only be long enough to go safely from the patient to the pump and facilitate patient transport. • It is better to use fewer connectors as possible. Each connector within the circuit causes the creation of a turbulent flow area. In these areas, clots may form more easily. • Check for the absence of kinks, twists, and the right connections of the fluid tubing in the entire circuit. • Use only what is essential for the good performance of the circuit as it makes it in such a way that it is possible to deal with unforeseeable situations. • Dual lumen cannula insertion in the jugular vein should be done under transesophageal echocardiographic control for the risk of myocardial perforation. • In VA (veno-arterial)-ECMO, avoid limb ischemia by using end-to-side chimney graft or by positioning a distal perfusion cannula.