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 SaO 2  > 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 ( I njury S everity S core 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 H orovitz‐ I ndex <80 mmHg), and vv ECMO therapy was initiated. The H orovitz‐ I ndex was <80 mm H g, and the lung compliance was minimal. With HFOV , almost complete recruitment of the lung was achieved, and the fraction of inspired oxygen ( FiO 2 ) 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.