Use of extracorporeal membrane oxygenation in combination with high‐frequency oscillatory ventilation in post‐traumatic ARDS

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life‐threatening complications in trauma patients. Despite the implantation of a veno‐venous extracorporeal membrane oxygenation (vv ECMO), sufficient oxygenation (arterial SaO₂ > 90%) is not always achieved. The additive use of high‐frequency oscillation ventilation (HFOV) and ECMO in the critical phase after trauma could prevent the occurrence of life‐threatening hypoxaemia and multi‐organ failure. We report on a 26‐year‐old female (Injury Severity Score 29) who had multiple injuries as follows: an unstable pelvic fracture, a blunt abdominal trauma, a blunt trauma of the left thigh, and a thoracic injury. Three days after admission, the patient developed fulminant ARDS (Murray lung injury score of 11 and Horovitz‐ Index <80 mmHg), and vv ECMO therapy was initiated. The Horovitz‐ Index was <80 mm Hg, and the lung compliance was minimal. With HFOV, almost complete recruitment of the lung was achieved, and the fraction of inspired oxygen (FiO₂) was significantly reduced. The pelvic fracture was treated non‐operatively. The HFOV was terminated after 3 days, and the ECMO was stopped after 19 days.