CASE REPORT article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Veno-venous ECMO-Assisted Orthopedic Stabilization for Polytrauma with Severe ARDS and Refractory Hypoxemia: A Case Report
Provisionally accepted
- Honghui Hospital, Xi'an, China
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This case report describes the successful integration of veno-venous extracorporeal membrane oxygenation (VV-ECMO) with physiologically optimized fracture fixation in a critically ill polytrauma patient who presented with life-threatening acute respiratory distress syndrome (ARDS). A 23-year-old male with bilateral femoral fractures, Gustilo IIIB open tibiofibular injury, left radius-ulna fractures, and refractory hypoxemia (PaO₂/FiO₂ 40.5 mm Hg) underwent VV-ECMO initiation 1 hour postinjury (total ECMO duration 144 hours). Physiological optimization guided delayed surgical intervention on day 5, incorporating heparin-based anticoagulation and dynamic ECMO parameter modulation, resolving lactic acidosis (peak lactate 5.0 mmol/L on day 1 to 1.8 mmol/L preoperatively). The patient achieved successful decannulation by day 6 with satisfactory recovery at the 2-month follow-up (Short Musculoskeletal Function Assessment (SMFA) score 28.1, gait speed 1.2 m/s). This case demonstrates the feasibility of a multidisciplinary protocol challenging traditional contraindications to surgery in severe ARDS patients and providing a replicable protocol for managing competing priorities of oxygenation and hemorrhage control.
Keywords: ECMO, polytrauma, anticoagulation, ARDS, Damage control orthopedics
Received: 22 Aug 2025; Accepted: 31 Oct 2025.
Copyright: © 2025 Liu, Deng, Tang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yanjun Wang, thomaswyj@163.com
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