ECMO AND SURGICAL STABILIZATION OF RIB FRACTURES IN SEVERE CHEST TRAUMA

Objectives: Blunt chest trauma accounts for a quarter of traumatic deaths. Rib fractures and flail chest alter pulmonary mechanics which when combined with pulmonary contusions and lacerations can lead to respiratory failure. Early surgical stabilization of rib fractures (SSRF) has shown improved outcomes though this must be balanced with the risks of surgery in critically ill patients. We present a case of a 40-year-old male presenting after being run over by a forklift. He sustained significant chest wall and pulmonary trauma resulting in respiratory failure. He was placed on venovenous extracorporeal membrane oxygenation (ECMO) emergently and was taken for SSRF on hospital day 3. Given the extent of his chest wall trauma, reconstruction was necessary to restore sufficient pulmonary mechanics to transition off of ECMO. Four days following chest wall reconstruction, ECMO was decanulated. He was ultimately discharged to a rehabilitation facility and has had a good functional recovery. This case demonstrates successful management of severe chest wall trauma and respiratory failure with ECMO and early SSRF.

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