R . Alejandro Díaz Gómez et al .: J Extra Corpor Technol 2025 , 57 , 38 – 41 39
Figure
1 . ECPR CANNULATION in the operating room the patient presented the arrest and the ECMO team came in , reevaluated the situation and proceeded to go on with cannulation .
27 observational studies , and 6 cost-effectiveness analyses , indicating the potential benefits of ECPR [ 4 ].
The survival advantage of open-chest CPR ( OCCPR ) compared to closed-chest CPR ( CCCPR ) remains uncertain . CCCPR is the standard practice [ 5 ], however , European guidelines advise considering open-chest cardiac massage during a peri-operative cardiac arrest if ROSC cannot be achieved through closed compressions and ECPR is not available [ 6 ].
Trauma does not rule out the use of ECMO , which has been utilized more frequently in this situation . Advances in anticoagulation and technology strive to reduce associated complications . While formal guidelines have yet to be established , clinicians recognize its potential life-saving benefits for critically injured patients [ 7 ].
At the moment of establishing a “ system ” for a situation like this , Germany ’ s Düsseldorf ECLS Network offers advanced mechanical support for critically ill patients at multiple centers . Of the 160 patients , 102 received ECMO during cardiac arrest , with a 34 % survival rate to discharge [ 8 ]. The rendezvous model strategy aims to enhance patient outcomes by initiating ECMO support earlier in the prehospital environment , utilizing a central hub that serves multiple centers , and then back to a central ECMO hospital once cannulated . This approach necessitates extensive planning , logistics , and collaboration among various institutions [ 9 ]. A cannulation team in Southern California successfully transported patients requiring ECMO support . This included several ECPR cases involving drug overdoses and refractory arrhythmias [ 10 ].
Description
A 34-year-old male patient with no significant past medical history presented to the emergency department of a public hospital in Chile , shortly after a traffic collision . The patient presented with blunt chest trauma , including left hemopneumothorax , multiple rib and sternal fractures , thoracic vertebral fractures ( T1 ; T4-T8 ), an open fracture of the left wrist and a fracture of the left elbow . Additionally , blunt abdominal trauma led to a splenic injury . Consequently , DVT prophylaxis was not indicated .
Upon hospital arrival , a pleurostomy was performed but was found to be ineffective , with impaction into the lung parenchyma and no air or blood was drained . Due to reasons beyond the medical team ’ s control , surgical removal of this tube and drainage of hemopneumothorax was planned seven days after admission . The patient at that time was in good general condition , hemodynamically stable with no vasoactive drugs , spontaneous ventilation , with no O 2 required .
At the beginning of the surgery , the patient unexpectedly experienced loss of the capnography waveform . While investigating the cause , the patient developed ventricular fibrillation ( VF ), followed by asystole . The surgical procedure was immediately halted and the patient was placed in the supine position . Following confirmation of pulselessness , CPR was initiated according to established protocols . A thoracotomy was performed to rule out cardiac tamponade , and internal cardiac massage was initiated , followed by direct defibrillation . The