Extracorporeal Membrane Oxygenation Use in Fat Embolism Syndrome: Current Perspectives and Clinical Insights (A 20-Year Review)

Background/Objectives: Fat embolism syndrome (FES) is a rare but serious complication that may arise after long bone fractures, characterized by fat globules entering the bloodstream and causing multi-organ dysfunction, particularly respiratory failure. While initial treatment focuses on supportive care including oxygen therapy, fluid management, and hemodynamic stabilization, severe cases may require advanced life support, such as extracorporeal membrane oxygenation (ECMO). The aim of this study is to evaluate the role of ECMO in managing severe cases of FES with refractory hypoxemia and hemodynamic instability by analyzing patient outcomes. Methods: This mini-review explores the role of ECMO in managing FES by analyzing published case reports from the first documented case in 2004 and reviewing the broader literature. By examining the physiological principles, clinical applications, and reported outcomes of ECMO in FES, we aim to provide insights into its potential benefits and limitations. Results: A total of 12 case reports were identified and evaluated for eligibility. All 12 cases met the inclusion criteria and were included in the analysis. These cases involved patients who had FES-related refractory hypoxemia and required ECMO support. Conclusions: Our analysis of case reports presents supportive evidence that incorporating ECMO into the management of FES serves as a crucial bridge to recovery for patients who do not respond to conventional therapies.