Inhalation injury, large total body surface area (TBSA) burned, and subsequent acute respiratory distress syndrome (ARDS) are significant predictors of mortality in patients with burn injuries [1,2]. Inhalation injury often results in airway inflammation, pulmonary vascular shunting, microvascular pressure gradient, and severe hypoxemia. As a result, inhalation injury itself increases mortality by adding 17 points to the Baux score; this has been termed the revised Baux score [3,4]. As an inflammatory response to burned skin, ARDS causes microvascular damage to the pulmonary endothelium [5,6]. The treatment strategies for inhalation injury and ARDS include mechanical ventilation, adequate fluid resuscitation, and heparin nebulization. However, both remain primary causes of death in major burn patients [7]. Previous cohort studies have reported that extracorporeal life support (ECLS) benefits burn victims, which has led to widespread utilization of ECLS for burn- and inhalation-related injuries [8], [9], [10]. However, limited studies have reported the efficacy of ECLS in patients with severe burn injury, concomitant inhalation injury, and subsequent ARDS. Furthermore, major burns with concomitant inhalation injury and ARDS are common in wars. It is important for military medical centers to improve their management of such a serious clinical issue. Therefore, this study evaluates the efficacy of ECLS in these extremely critical patients and discussed the potential risk factors of mortality.

This study was approved by the ethical committee of our institution, the Institutional Review Board of Tri-Service General Hospital (TSGHIRB No.: C202005124, Date of Approval: 2020/9/2). Furthermore, all methods were performed in accordance with the relevant guidelines and regulations. The need for informed consent was waived by the ethics committee based on the retrospective nature of the study. Patients’ consents were obtained according to the Declaration of Helsinki.