Introduction: The role of extracorporeal membrane oxygenation (ECMO) in penetrating trauma is under-explored, with most existing trauma literature describing its use in blunt injuries. We hypothesized that ECMO is a feasible support therapy in select penetrating trauma patients. Methods: Penetrating trauma patients treated with ECMO at a level 1 trauma center from January 2022 to June 2025 were retrospectively reviewed. Respiratory ECMO Survival Prediction (RESP) classes were calculated for each patient. The primary outcome assessed was survival. Results: Eight patients with penetrating trauma underwent veno-venous (VV) ECMO during the study period. All were male with a median age of 36 IQR 25, 50 years and median injury severity score of 20 16, 28. Mechanisms of injury included gunshot wounds (n=6) and stab wounds (n=2). Five patients had primary thoracic injuries. Indications for ECMO included trauma-related respiratory failure (n=3), COVID-19 pneumonia (n=1), bacterial pneumonia (n=1), aspiration (n=1), unknown etiology (n=1), and airway support during bronchial repair (n=1). The median PaO2/FiO2 ratio at consultation was 71 66, 100, and RESP classes ranged from I to IV. Median time to ECMO initiation from admission was 3 1, 4 days. Anticoagulation (AC) was initiated within 3 days in 3 patients and eventually administered in 7 patients. 3 patients had bleeding complications (bloody secretions, pulmonary hemorrhage, cannula site bleeding). Thrombotic events occurred in 3 patients (2 deep vein thromboses, 1 pulmonary embolus), none associated with AC interruption. AC was held in 3 cases without thrombotic sequelae. Four patients underwent surgery while on ECMO. Median ECMO duration was 14 8, 20 days. Six patients survived (5 discharged home, 1 to acute inpatient rehabilitation) and two died (one from hemorrhage, one from sepsis after decannulation). Conclusions: VV ECMO is a feasible support option for select penetrating trauma patients, with relatively favorable outcomes observed with and without early AC. This is the largest case series of ECMO use in penetrating trauma at a single institution. Prospective studies are needed to refine patient selection and develop evidence-based management protocols to enhance safety and efficacy.
Arcieri et al. (Sun,) studied this question.