Non-heparinized veno-venous ECMO applied to trauma patient with severe hypovolemic shock and hypothermia: A case report

Abstract

RATIONALE: Extracorporeal membrane oxygenation (ECMO) can provide life-saving circulatory and thermal support in patients with severe trauma complicated by massive hemorrhage, conditions where conventional resuscitation may be insufficient. This report presents a case demonstrating that heparin-free veno-venous ECMO can be safely implemented in selected trauma patients to stabilize hemodynamics, restore normothermia, and facilitate definitive surgical management. PATIENT CONCERNS: We report the case of a 26-year-old male who sustained multiple traumatic injuries after a traffic accident, most notably a left above-knee amputation that resulted in massive hemorrhage, along with minor right-toe fracture. The patient's hemodynamic status was unstable due to excessive hemorrhage and hypothermia. DIAGNOSES: Severe traumatic hemorrhage with hypothermia following left above-knee amputation. INTERVENTIONS: To enable aggressive resuscitation, heparin-free veno-venous ECMO (VV ECMO) was initiated peripherally via both femoral veins. ECMO provided circulatory and thermal support, allowing massive transfusion, restoration of normothermia, and stabilization for subsequent orthopedic surgery. OUTCOMES: ECMO enabled restoration of normothermia and hemodynamic stabilization, allowing subsequent orthopedic surgery for definitive bleeding control. The patient was weaned from mechanical ventilation on postoperative day 21, underwent tracheal decannulation on day 33, and was discharged on postoperative day 170 in a stable condition with full cognitive recovery. LESSONS: In patients with severe trauma and hemorrhage, the application of ECMO, provided that clinically viable bleeding control is achieved, is thought to facilitate effective blood transfusion and help prevent hypothermia caused by massive hemorrhage and transfusion. © © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.