Ryder Practice Guidelines for ECMO in Trauma

• Failure to meet ventilation and oxygenation goals with maximal medical management

• Severe Respiratory failure ≥ 7 days
• Non-Reversible etiology of respiratory failure
• Physiologic frailty prior to injury
• BMI > 45 kg/m2
• Neurologic devastation
• DNR
• Ongoing bleeding (unless immediately correctable, pending OR/IR)
• Necrotizing Pneumonia
• Advanced multisystem organ failure
• High pre-injury morbidity (terminal disease, patients with metastatic malignancy, major central nervous system injury, or quadriplegia)

*Biderman, P., et al., Extracorporeal life support in patients with multiple injuries and severe respiratory failure: a single‐center experience? The Journal of Trauma and Acute Care Surgery, 2013. 75(5): p. 907–912.
Michaels, A.J., et al., Extracorporeal life support in pulmonary failure after trauma. The Journal of Trauma, 1999. 46(4): p. 638–645.

• Consult to Trauma ECMO service initiated by treating attending (trauma team or ICU)
• If there is question about eligibility, then a third party from Jackson ECMO hotline will provide input on decision.

• Trauma ECMO patients will be cared for in the TICU
• The care is provided by the TICU or Burn Service
• The Trauma ECMO service will follow daily for ECMO and ICU management.
• The Trauma ECMO service will add continuity of care and when ECMO providers change a sign out will ensure longitudinal understanding of goals.

• Perfusionist administered via contract with Jackson Memorial Hospital (JMH)
• ECMO machine hardware provided by machines owned by JMH