Management of Gangrenous Bowel Post-ECMO

Immediate Surgical Intervention Required

The World Journal of Emergency Surgery recommends immediate surgical resection of gangrenous bowel, with the surgical approach determined by hemodynamic stability and extent of ischemia 1, 2

For hemodynamically stable patients, perform limited intestinal resection with primary anastomosis if the gangrenous segment is clearly demarcated, and consider using indocyanine green (ICG) fluorescence angiography to evaluate bowel perfusion and anastomotic viability 1, 2, 4
For hemodynamically unstable patients, implement damage control surgery with open abdomen approach, resect only obviously gangrenous bowel, and avoid primary anastomosis 1, 2

Systematically inspect the entire small bowel from ileocecal junction proximally to identify all areas of ischemia, as skip lesions are common in low-flow states 2, 3

Plan for re-exploration within 24-48 hours if damage control surgery was performed, to reassess bowel viability and definitively manage the abdomen 1
Maintain aggressive hemodynamic support and correct coagulopathy, and monitor for anastomotic complications if primary anastomosis was performed 1