{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T15:24:56Z","timestamp":1769181896574,"version":"3.49.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>This case report describes the successful integration of veno-venous extracorporeal membrane oxygenation (VV-ECMO) with physiologically optimized fracture fixation in a critically ill polytrauma patient who presented with life-threatening acute respiratory distress syndrome (ARDS). A 23-year-old male with bilateral femoral fractures, Gustilo IIIB open tibiofibular injury, left radius-ulna fractures, and refractory hypoxemia (PaO2\/FiO2 40.5 mm Hg) underwent VV-ECMO initiation 1 h postinjury (total ECMO duration 144 h). Physiological optimization guided delayed surgical intervention on day 5, incorporating heparin-based anticoagulation and dynamic ECMO parameter modulation, resolving lactic acidosis (peak lactate 5.0 mmol\/L on day 1 to 1.8 mmol\/L preoperatively). The patient achieved successful decannulation by day 6 with satisfactory recovery at the 2-month follow-up [Short Musculoskeletal Function Assessment (SMFA) score 28.1, gait speed 1.2 m\/s]. This case demonstrates the feasibility of a multidisciplinary protocol challenging traditional contraindications to surgery in severe ARDS patients and providing a replicable protocol for managing competing priorities of oxygenation and hemorrhage control.<\/jats:p>","DOI":"10.3389\/fmed.2025.1688556","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T14:08:49Z","timestamp":1769177329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Veno-venous ECMO-assisted orthopedic stabilization for polytrauma with severe ARDS and refractory hypoxemia: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Lin","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Emergency, Honghui Hospital, Xi\u2019an Jiaotong University, Xi\u2019an","place":["Shaanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaiji","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Emergency, Honghui Hospital, Xi\u2019an Jiaotong University, Xi\u2019an","place":["Shaanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haifeng","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Emergency, Honghui Hospital, Xi\u2019an Jiaotong University, Xi\u2019an","place":["Shaanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanjun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency, Honghui Hospital, Xi\u2019an Jiaotong University, Xi\u2019an","place":["Shaanxi, 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