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Review
. 2025 Aug 20;14(1):89.
doi: 10.1186/s13741-025-00572-2.

Management of burn patients undergoing surgery while on extracorporeal membrane oxygenation (ECMO): clinical experience and a standardized perioperative protocol

Sonja Verena Schmidt  1 , Elisabete Macedo Santos  2 , Marius Drysch  3 , Flemming Puscz  3 , Felix Reinkemeier  3 , Dirk Buchwald  4 , Peter K Zahn  2 , Marcus Lehnhardt  3 , Jannik Hinzmann #  3 , Christoph Wallner #  3
Affiliations
Review

Management of burn patients undergoing surgery while on extracorporeal membrane oxygenation (ECMO): clinical experience and a standardized perioperative protocol

Sonja Verena Schmidt et al. Perioper Med (Lond). .

Abstract

Severe burn injuries complicated by acute respiratory failure present unique challenges in critical care medicine. Although the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) can offer life-saving support for this patient cohort, the perioperative management of burn patients on ECMO remains poorly standardized, and evidence-based guidelines are lacking. This perspective outlines the experiences gained from managing burn patients undergoing surgery while on V-V ECMO at a major burn center. Over a 3-year period, 14 patients with an average burned total body surface area (TBSA) involvement of 41% were treated with ECMO support. Several key strategies contributed to the safe surgical management of these patients. Looking ahead, there is a clear need for multicenter registry data and collaborative efforts to establish standardized perioperative protocols for burn patients receiving ECMO. Individualized anticoagulation management using point-of-care techniques such as thromboelastography, and the evaluation of optimal surgical timing strategies, will be essential areas for future research. In conclusion, interdisciplinary teamwork and structured perioperative management protocols can enable safe surgical treatment of burn patients on ECMO. Broader collaboration and standardized data collection are crucial steps to improving outcomes and establishing best practices for this complex patient population.

Keywords: Anticoagulation; Burn surgery; ECMO; Intensive care; Perioperative medicine.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable as it is not a study but an observation of patients treated in the regular setting. This observation is based on a retrospective analysis of routine clinical data collected within our own department. In accordance with § 6 of the Health Data Protection Act of North Rhine-Westphalia (GDSG NRW) and § 15 (1) of the Professional Code of Conduct of the Medical Association of Westphalia-Lippe, no patient consent or formal ethics approval is required in this case, as the data were extracted exclusively from internal patient records by individuals directly involved in the patients’ clinical care. The data were handled in compliance with data protection regulations and used solely in anonymized form for scientific analysis. According to these regulations, consultation of an ethics committee is not mandatory for such departmental, retrospective, and anonymized evaluations in publicly governed institutions. Consent for publication: Not applicable as data is pseudonymized and no personal information are included in the manuscript. Competing interests: The authors declare no competing interests.

References

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