Femoral shaft fracture osteosynthesis in a critically ill patient under Extracorporeal Membrane Oxygenation (ECMO)

Abstract

Extracorporeal Membrane Oxygenation (ECMO) is an invasive procedure used in critically ill patients with catastrophic pulmonary failure or cardiogenic shock in which conventional management has failed. These patients are managed with permanent anticoagulation, with increased bleeding risk. Hemorrhage is the main reported complication. Case: A 25-year-old polytraumatized woman, both lower limbs amputated and a left femoral shaft fracture with catastrophic pulmonary failure (Murray score 4) that required intensive management care with ECMO. During her evolution definitive femoral shaft osteosynthesis with a nail as required and the medical team decided to operate on the patient under ECMO. She recovered with fluctuations in her hematocrit, but was hemodynamically stable. The patient recovered satisfactorily, was weaned from ECMO and commenced her rehabilitation program. At 16 months, she was almost autovalent, and full consolidation was achieved, with no complication of the implants. Discussion: ECMO is a life-saving support, but requires permanent anticoagulation, which implies a high risk of hemorrhages, specially for surgical treatment. This patient underwent an osteosynthesis surgery satisfactorily. Hematoma was the only complication of her intramedullary femoral nail, without compromising hemodynamics. This case shows that patients on ECMO can undergo a major orthopedic surgery in selected cases.