Enhancing the detection of ECMO-related morphological changes: a post-mortem observational study and systematic review

Extracorporeal Membrane Oxygenation (ECMO) is a crucial life-support technology used in intensive care medicine for patients with severe cardiorespiratory failure who do not respond to conventional treatments. While ECMO can be lifesaving, it is a complex procedure that demands a multidisciplinary approach and a thorough understanding of its indications, contraindications, complications, and limitations. The application of ECMO also presents significant challenges for forensic medicine, as patients who undergo ECMO and later die may exhibit physiological changes that can lead to discrepancies between pre-mortem and post-mortem diagnoses. These changes can complicate the interpretation of autopsy findings and impact forensic conclusions. “A systematic review along with eight cases studies dealing with patients died after treatment with ECMO have been reported”. Each case underwent forensic autopsy to illustrate the potential post-mortem changes associated with ECMO and highlight the importance of understanding these effects when evaluating forensic cases. The authors propose a procedure for conducting an external examination before initiating ECMO treatment or during the initial hours of treatment to document and preserve the clinical condition in cases of forensic interest. This approach aims to provide a clearer and more accurate basis for forensic analysis, ensuring that any alterations due to ECMO are properly accounted for during autopsy.