Subscribe to RSS
Use of Extracorporeal Membrane Oxygenation for Major Cardiopulmonary ResectionsFunding None.
Background In thoracic surgery, utilization of extracorporeal membrane oxygenation (ECMO) is mainly established for patients undergoing lung transplantation. The aim of our study was to summarize our single-center experience with intraoperative use of veno-venous- or veno-arterial-ECMO in patients undergoing complex lung surgery involving the main carina, or the left atrium or the descending aorta.
Methods A total of 24 patients underwent combined complex lung, carinal, aortal, or left atrial resections. In cases of carinal resection, percutaneous veno-venous, jugular–femoral cannulation was considered suitable. For combined resection of lung and descending aorta, a percutaneous femoral veno-arterial cannulation was used. In cases of extended left atrial resection, a percutaneous jugular–femoral veno-venous-arterial cannulation was favored.
Results Procedures were divided into three groups: carinal resections and reconstruction (n = 8), resections of the descending aorta and left lung (n = 7), resections of lung and left atrium (n = 9). No intraoperative complications occurred. Overall 30-day mortality was 25%. A complete resection was achieved in 18 patients. Median survival was 12 months. One- and 5-year survival were 48.1 and 22.7%, respectively.
Conclusion The present study shows that intraoperative use of ECMO for extended carinal, aortic, or atrial resections is feasible with minimal intraoperative complications allowing surgeons increased operating-field safety. Perioperative mortality is high, but this is rather an attribute of local extended disease and patient comorbidities.
Received: 24 November 2019
Accepted: 27 January 2020
08 April 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Combes A, Hajage D, Capellier G. et al; EOLIA Trial Group, REVA, and ECMONet. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018; 378 (21) 1965-1975
- 2 McRae K, de Perrot M. Principles and indications of extracorporeal life support in general thoracic surgery. J Thorac Dis 2018; 10 (Suppl 8): S931-S946
- 3 Fan E, Karagiannidis C. Less is more: not (always) simple-the case of extracorporeal devices in critical care. Intensive Care Med 2019; 45 (10) 1451-1453
- 4 Combes A, Bréchot N, Luyt CE, Schmidt M. Indications for extracorporeal support: why do we need the results of the EOLIA trial?. Med Klin Intensivmed Notf Med 2018; 113 (Suppl 1): 21-25
- 5 Biscotti M, Gannon WD, Agerstrand C. et al. Awake extracorporeal membrane oxygenation as bridge to lung transplantation: a 9-year experience. Ann Thorac Surg 2017; 104 (02) 412-419
- 6 Hoechter DJ, Shen YM, Kammerer T. et al. Extracorporeal circulation during lung transplantation procedures: a meta-analysis. ASAIO J 2017; 63 (05) 551-561
- 7 Dartevelle PG, Mitilian D, Fadel E. Extended surgery for T4 lung cancer: a 30 years' experience. Gen Thorac Cardiovasc Surg 2017; 65 (06) 321-328
- 8 Kelly B, Carton E. Extended indications for extracorporeal membrane oxygenation in the operating room. J Intensive Care Med 2020; 35 (01) 24-33
- 9 Biscotti M, Yang J, Sonett J, Bacchetta M. Comparison of extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. J Thorac Cardiovasc Surg 2014; 148 (05) 2410-2415
- 10 Machuca TN, Collaud S, Mercier O. et al. Outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. J Thorac Cardiovasc Surg 2015; 149 (04) 1152-1157
- 11 Lang G, Ghanim B, Hötzenecker K. et al. Extracorporeal membrane oxygenation support for complex tracheo-bronchial procedures. Eur J Cardiothorac Surg 2015; 47 (02) 250-255 , discussion 256
- 12 Kim CW, Kim DH, Son BS. et al. The feasibility of extracorporeal membrane oxygenation in the variant airway problems. Ann Thorac Cardiovasc Surg 2015; 21 (06) 517-522
- 13 Byrne JG, Leacche M, Agnihotri AK. et al. The use of cardiopulmonary bypass during resection of locally advanced thoracic malignancies: a 10-year two-center experience. Chest 2004; 125 (04) 1581-1586
- 14 Ohta M, Hirabayasi H, Shiono H. et al. Surgical resection for lung cancer with infiltration of the thoracic aorta. J Thorac Cardiovasc Surg 2005; 129 (04) 804-808
- 15 Marulli G, Rendina EA, Klepetko W. et al. Surgery for T4 lung cancer invading the thoracic aorta: do we push the limits?. J Surg Oncol 2017; 116 (08) 1141-1149
- 16 Galvaing G, Tardy MM, Cassagnes L. et al. Left atrial resection for T4 lung cancer without cardiopulmonary bypass: technical aspects and outcomes. Ann Thorac Surg 2014; 97 (05) 1708-1713
- 17 Fukuse T, Wada H, Hitomi S. Extended operation for non-small cell lung cancer invading great vessels and left atrium. Eur J Cardiothorac Surg 1997; 11 (04) 664-669
- 18 Ratto GB, Costa R, Vassallo G, Alloisio A, Maineri P, Bruzzi P. Twelve-year experience with left atrial resection in the treatment of non-small cell lung cancer. Ann Thorac Surg 2004; 78 (01) 234-237
- 19 Antonia SJ, Villegas A, Daniel D. et al; PACIFIC Investigators. Durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. N Engl J Med 2017; 377 (20) 1919-1929
- 20 Rinieri P, Peillon C, Bessou JP. et al. National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation. Eur J Cardiothorac Surg 2015; 47 (01) 87-94