Tretter, Eric M.2025-06-182025-06-182025-06Tretter Eric M..Intraoperative Management of Hypoxemia with Anticoagulant-Free Venovenous Extracorporeal Membrane Oxygenation Amid Diagnostic Uncertainty.Annals of Cardiac Anaesthesia.2025 Jun;28(2):187-1890971-97840974-5181https://imsear.searo.who.int/handle/123456789/247979Clinically relevant fat embolism syndrome (FES) is a potentially fatal intraoperative event, particularly in trauma patients. Rapid diagnosis is challenging in the perioperative setting, but treatment requires swift intervention and multidisciplinary coordination. This case report presents a polytrauma patient undergoing pelvic ring fixation who developed refractory hypoxia secondary to suspected FES. Successful initiation of anticoagulant?free venovenous extracorporeal membrane oxygenation (ECMO) intraoperatively, without definitive diagnosis, resulted in patient survival. Given the paucity of large?scale studies detailing the efficacious use of ECMO for FES in the perioperative setting, this report serves to expand the growing understanding of treatment for this potentially catastrophic event.Extracorporeal membrane oxygenationfat embolismhypoxemiapolytraumaJournal ArticleIndiaDepartment of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX, United States; Department of Anesthesiology and Pain Management, Parkland Health and Hospital System, Dallas, TX, United States