26: Interdisciplinary Collaboration for VV-ECMO Insertion in a Polytrauma Patient

Introduction: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a life-saving intervention for respiratory failure when conventional therapies fail. Multidisciplinary team approach in polytrauma patients is crucial. This case report illustrates how collaborative efforts can effectively manage critical situations during ECMO troubleshooting. Methods: An 18-year-old male sustained severe polytrauma from a motor vehicle accident, presented with significant bilateral lung contusions, a pelvic fracture, and bilateral femur fractures. Due to worsening lung mechanics and increased oxygen requirements despite maximum mechanical ventilation, VV-ECMO was indicated as proning was not feasible. An interdisciplinary team, including an ECMO physician, trauma surgeon, and orthopedic surgeon, led to a collaborative discussion of dual lumen internal jugular cannulation to facilitate early internal fixation of the femur. During insertion, difficulties arose with wire progression in the right internal jugular vein due to partial thrombosis. Pre-scanning of the left side revealed thrombosis as well. An urgent on-site interdisciplinary discussion explored the consideration of femoral access, with possible modified orthopedic fixation plan. The collaborative plan involved a femoral-femoral approach and temporary external fixators for initial stabilization till recovery. VV-ECMO was successfully established via the fem-fem approach, leading to improved lung mechanics, decreased oxygen requirements, and eventual weaning from ECMO and ventilator. The patient was discharged after internal fixation of his bilateral femur fractures. Results: VV-ECMO in polytrauma patients is challenging due to multiple fractures, difficult access, and non-ideal conditions for proning and anticoagulation. This case demonstrates the importance of a collaborative multidisciplinary team approach in developing personalized patient care plan for successful outcomes. Conclusion: While VV-ECMO is effective for respiratory failure, its insertion poses challenges in polytrauma cases. Coordinating multiple specialties can introduce delays in urgent situations, emphasizing the need for rapid decision-making. This case highlights the importance of careful planning and multidisciplinary collaboration in optimizing patient outcomes.