In the setting of trauma, most patients requiring pneumonectomy do not survive.1"3 When compared with lung-sparing operations, pneumonectomy for control of major hemorrhage is associated with increased blood loss, more prolonged and severe respiratory failure, longer intensive care unit and hospital stays, and greater intraoperative as well as overall mortality. Despite the recognition of an improved outcome when a lung-sparing procedure is possible, complete pneumonectomy is occasionally necessary for devastating injury, both for penetrating and blunt trauma patients. In the event that the patient survives the initial pneumonectomy, postoperative management is challenging due to hypoxemia and right heart failure. Various techniques in ventilator management can be used to support these patients with severe respiratory failure, but one additional tool in this setting of severe hypoxemia is Extracorporeal Life Support, or Extra-corporeal Membrane Oxygenation (ECMO), a modified form of cardiopulmonary bypass. There is little data on the use of ECMO in posttraumatic pneumonectomy, with most series reporting small numbers of patients, but ECMO remains a viable option for the hypoxemic patient, as the following case demonstrates.
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