The Success of ECMO in Flail Chest and ARDS Following Thoracic Gunshot Wound

Extracorporeal membrane oxygenation (ECMO) may be the last option in patients with severe acute respiratory distress syndrome (ARDS) in whom conventional methods have failed. The best results are obtained in patients with severe ARDS after trauma. Injured lungs can recover completely with ECMO therapy. A 44-year-old male patient was brought to the emergency department after sustaining severe thoracic gunshot injury. The patient was rushed into emergency surgery; however, pneumonectomy could not be performed due to morphological variation and widespread contusion in the lungs. The patient had flail chest with extensive damage of the ribs. Titanium plates could not be placed, as there was a major loss in the bone tissue. After cutting the fractured rib ends, the open chest wall was repaired with dual mesh and covered with serratus and latissimus dorsi muscles. However, the flail chest could not be corrected. During the follow-up in the intensive care unit, the patient developed ARDS and conventional therapies were unsuccessful. Thus, ECMO was used to allow lung healing. ECMO treatment was continued for seven days and was completed without any complications. The patient was transferred to the regular ward after 29 days. ECMO can be used as a life-saving treatment that allows lung healing in case conventional treatment methods have failed.