39: Successful Application of Heparin-Free VV-ECMO in a Multiple Trauma Patient: A Case Report

Introduction: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) plays a crucial role in respiratory failure management, however its use in trauma patients is uncertain and outcomes vary. This case report discusses the application of heparin-free VV-ECMO in a multiple trauma patient. Case Presentation: A previously healthy 18-years-old male patient was admitted to the hospital following a motor vehicle accident. He sustained severe bilateral lung contusions, pelvic fracture with pelvic hematoma, and bilateral femur fractures with intramuscular hematomas, necessitating massive blood transfusion. Due to worsening lung mechanics and increased oxygen requirements, he was unresponsive to mechanical ventilation. Bilateral femoral VV ECMO was initiated without anticoagulation due to a high bleeding risk. Over time the patient’s lung mechanics improved, oxygen requirement decreased, and ECMO was successfully weaned. The patient was subsequently weaned from mechanical ventilation, extubated, and discharged home after internal fixation of his bilateral femur fractures. The patient successfully recovered and was discharged home. Conclusions: VV-ECMO in multiple trauma patients is challenging due to the need for systemic anticoagulation. There are significant limitations including the risk of thrombosis in the ECMO circuit and pump head failure, which can lead to catastrophic events. Therefore, a careful assessment of the risks and benefits of anticoagulation versus anticoagulation-free ECMO is crucial. This case highlights the feasibility of heparin-free VV-ECMO in critically injured patients with multiple traumas. It emphasizes the importance of a multidisciplinary team approach in managing severe respiratory failure with bleeding risks.