Battlefield mechanical ventilation and extracorporeal membrane oxygenation: A scoping review

Background: Casualties of military conflicts suffer a multitude of injuries, and recent research has documented a significant number develop acute respiratory distress syndrome (ARDS). The present study undertakes a scoping review of research on the treatment of ARDS in combat casualties near the battlefield.

Methods: We review the extent of the current ARDS care, from intubation and mechanical ventilation (MV) to the use of extracorporeal membrane oxygenation (ECMO), and how the respective echelons of care across the Military Health System (MHS) are involved in the care of these patients. Online databases were used to identify article published 1988-2022, from which we selected 112 publications from various countries including the USA, UK, Germany, Italy, and India that used military relevant keywords (i.e., battlefield, combat, deployed, military trauma), in the titles or abstract in conjunction with the MeSH descriptors for battlefield respiratory failure, and MV or ECMO.

Results: Mechanical ventilation and ECMO have clearly moved forward with progressions in technologies and now are routinely used and are well documented in the prehospital setting and during aeromedical transport. Overview of the MHS and descriptive analysis of battlefield casualties are well represented in the literature. There are multiple publications on airway management on the battlefield and innumerable regarding the somewhat comparable civilian prehospital trauma airway management.

Conclusion: While there is an abundance of publications on MV in the prehospital and combat environments, there are few case examples of the use of ECMO on the battlefield. Although MV may be required for many combat casualties, airway management failure remains the second leading cause of preventable death on the battlefield.