32: VV-ECMO in Blunt Thoracic Injury: A Bridge to Definitive Surgical Intervention and Pulmonary Recovery

Introduction: VV ECMO is indicated for reversible respiratory failure after blunt chest injury with flail chest who do not respond to conservative management. It is a bridge to recovery and allows for surgical stabilization of rib fractures, reducing infections, ventilator days, hospital stay, and overall mortality. VV ECMO is used as a salvage therapy in blunt thoracic trauma with multiple bilateral rib fractures, flail chest, lung contusions, and subcutaneous emphysema when pain, hypoxia, and ARDS persist despite maximal medical therapy. It serves as a bridge to both recovery and surgical intervention. Case Report: A 48-year man sustained severe blunt chest injury in a road traffic accident, presenting with extensive bilateral rib fractures, flail chest, subcutaneous emphysema, and persistent pneumothorax (ICD placed) with hypoxia unresponsive to conventional management. After ventilation optimization and placement of a second ICD for persistent air leak, the criteria for VV ECMO were met on day 3 (P/F 77, Murray 3, low compliance). ECMO was started as a bridge for rib fixation and recovery. Gradual improvement allowed ECMO weaning, tracheostomy, and eventual decannulation on day 7. During ICU stay he developed VAP- Acinetobacter XDR, treated with appropriate antibiotics as per sensitivity. Postoperatively with active pulmonary and physical rehabilitation his general condition improved and later shifted to outside hospital for further care. Conclusion: ECMO provides life-saving support in severe chest trauma, acting as a bridge for intervention and recovery. In patients where conservative treatment fails, ECMO should be considered, especially with ongoing hypoxia, chest wall instability, or when surgical stabilization is delayed. Attention is required for TBI patients needing higher oxygenation. ECMO shortens ventilation time, infections, and improves long-term outcomes. Limitations - ECMO center expertise, cost, and need for more RCTs. Clinical Significance: VV ECMO serves as a life-saving rescue therapy for severe, refractory respiratory failure.