This study aims to evaluate a new wound treatment called cold atmospheric plasma (CAP) for patients receiving extracorporeal life support (ECLS). Patients on extracorporeal life support (ECLS) often develop wounds at the sites where tubes are inserted, and these wounds can be difficult to heal and prone to infection.

cold atmospheric plasma (CAP) is a gentle, non-heat treatment that can kill bacteria, reduce inflammation, and promote wound healing. In this study, patients will be randomly assigned to receive either standard wound care alone or standard care plus cold atmospheric plasma (CAP) treatment.

Researchers will compare both groups to see whether cold atmospheric plasma (CAP) can reduce infection, improve healing speed, and decrease the need for additional procedures. The study will also monitor safety to ensure the treatment is well tolerated.

The goal is to find a more effective and safe way to improve wound healing in critically ill patients.

This study is a prospective, randomized controlled trial designed to evaluate the clinical efficacy and safety of cold atmospheric plasma (CAP) as an adjunctive therapy for wound management in patients receiving extracorporeal life support (ECLS). Cannulation site wounds in extracorporeal life support (ECLS) patients are frequently complicated by persistent bacterial colonization, biofilm formation, and impaired healing, which contribute to increased morbidity and healthcare burden.

Participants will be randomly assigned in a 1:1 ratio to receive either standard wound care alone or standard wound care combined with cold atmospheric plasma (CAP) treatment. cold atmospheric plasma (CAP) will be applied directly to the wound surface using an approved medical device at predefined intervals, in accordance with manufacturer guidelines and institutional protocols.

The study will incorporate multimodal assessments to comprehensively evaluate treatment effects. Quantitative bacterial burden will be assessed using fluorescence imaging techniques, supplemented by microbiological cultures. Local wound inflammation and healing responses will be evaluated through cytokine analysis of wound exudates. Clinical wound healing progression will be monitored using validated scoring systems, wound surface measurements, and documentation of time to complete epithelialization. The frequency of surgical debridement and incidence of clinically significant wound infections will also be recorded.

Safety will be closely monitored by documenting any adverse events associated with cold atmospheric plasma (CAP) application, including local skin reactions or discomfort. Outcome assessors will be blinded to treatment allocation where feasible to minimize bias.

This study seeks to determine whether cold atmospheric plasma (CAP) therapy can reduce microbial burden, modulate local inflammatory responses, and accelerate wound healing, thereby providing evidence for its potential integration into routine wound care practices for critically ill patients undergoing Extracorporeal Life Support (ECLS).

Inclusion Criteria:

• Age ≥ 18 years
• Receiving extracorporeal life support (ECLS)
• Presence of cannulation site wound requiring wound care

Exclusion Criteria:

• Pre-existing severe dermatological conditions at the cannulation site
• Severe coagulopathy precluding local intervention
• Concurrent receipt of other experimental wound treatments
• Life expectancy < 48 hours

Individual participant data (IPD) generated from this study will not be publicly shared due to concerns regarding patient privacy, data confidentiality, and institutional regulations. Although all data will be de-identified, the study involves a relatively small and specific patient population, which may increase the risk of re-identification. Additionally, data sharing is subject to approval by the Institutional Review Board (IRB) and applicable data protection policies.

Requests for access to limited, de-identified data may be considered on a case-by-case basis for legitimate academic or research purposes, subject to appropriate data use agreements and ethical approvals.

Due to the nature of the intervention, participants and treating clinicians will not be blinded to group allocation. However, outcome assessors-including wound care nurses evaluating clinical wound scores, microbiology personnel analyzing bacterial cultures, and laboratory staff measuring cytokine levels-will be blinded to treatment assignment where feasible. In addition, wound photographs and fluorescence imaging data will be assessed using standardized methods by blinded reviewers to minimize assessment bias.