CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg
DOI: 10.1055/s-0043-1770738
Original Thoracic

Outcome of Emergency Pulmonary Lobectomy under ECMO Support in Patients with COVID-19

Ana Beatriz Almeida
1   Department of Surgery, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
1   Department of Surgery, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
Peter Spieth
2   Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Sachsen, Germany
Attila Dubecz
3   Department of General and Thoracic Surgery, Klinikum Nuremberg, Nuremberg, Germany
Marcelo Gama de Abreu
4   Department of Anesthesiology, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, United States
Torsten Richter
2   Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Sachsen, Germany
Patrick Kellner
5   Department of Anesthesiology and Intensive Care, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
› Author Affiliations
Funding None.


Background Not much is known about the results of nonelective anatomical lung resections in coronavirus disease 2019 (COVID-19) patients put on extracorporeal membrane oxygenation (ECMO). The aim of this study was to analyze the outcome of lobectomy under ECMO support in patients with acute respiratory failure due to severe COVID-19.

Methods All COVID-19 patients undergoing anatomical lung resection with ECMO support at a German university hospital were included into a prospective database. Study period was April 1, 2020, to April 30, 2021 (first, second, and third waves in Germany).

Results A total of nine patients (median age 61 years, interquartile range 10 years) were included. There was virtually no preexisting comorbidity (median Charlson score of comorbidity 0.2). The mean interval between first positive COVID-19 test and surgery was 21.9 days. Clinical symptoms at the time of surgery were sepsis (nine of nine), respiratory failure (nine of nine), acute renal failure (five of nine), pleural empyema (five of nine), lung artery embolism (four of nine), and pneumothorax (two of nine). Mean intensive care unit (ICU) and ECMO days before surgery were 15.4 and 6, respectively. Indications for surgery were bacterial superinfection with lung abscess formation and progressive septic shock (seven of nine) and abscess formation with massive pulmonary hemorrhage into the abscess cavity (two of nine). All patients were under venovenous ECMO with femoral-jugular configuration. Operative procedures were lobectomy (eight) and pneumonectomy (one). Weaning from ECMO was successful in four of nine. In-hospital mortality was five of nine. Mean total ECMO days were 10.3 ± 6.2 and mean total ICU days were 27.7 ± 9.9. Mean length of stay was 28.7 ± 8.8 days.

Conclusion Emergency surgery under ECMO support seems to open up a perspective for surgical source control in COVID-19 patients with bacterial superinfection and localized pulmonary abscess.


This study was presented at the 30th European Conference on General Thoracic Surgery in The Hague, The Netherlands, June 19–21, 2022. Also, presented at the SCTS Annual Meeting in Belfast (Northern Ireland, United Kingdom), May 8–10, 2022.

Publication History

Received: 11 December 2022

Accepted: 14 April 2023

Article published online:
03 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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  • References

  • 1 Brodie D, Abrams D, MacLaren G. et al. Extracorporeal membrane oxygenation during respiratory pandemics: past, present, and future. Am J Respir Crit Care Med 2022; 205 (12) 1382-1390
  • 2 Ramanathan K, Antognini D, Combes A. et al. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med 2020; 8 (05) 518-526
  • 3 Karagiannidis C, Bein T, Welte T. ECMO during the COVID-19 pandemic: moving from rescue therapy to more reasonable indications. Eur Respir J 2022; 59 (02) 2103262
  • 4 Whebell S, Zhang J, Lewis R. et al. Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study. Intensive Care Med 2022; 48 (04) 467-478
  • 5 Mariani AW, Pêgo-Fernandes PM. Thoracic surgery in a hospital dedicated to treating COVID-19: challenges and solutions. Clinics (São Paulo) 2020; 75: e1982
  • 6 Chang SH, Chen D, Paone D. et al. Thoracic surgery outcomes for patients with coronavirus disease 2019. J Thorac Cardiovasc Surg 2021; 162 (06) 1654-1664
  • 7 Zwaenepoel B, Vandewiele K, Peperstraete H. et al. Video-assisted thoracic surgery in critically ill COVID-19 patients on venovenous extracorporeal membrane oxygenation. Perfusion 2022; •••: 2676591221119319
  • 8 McRae K, de Perrot M. Principles and indications of extracorporeal life support in general thoracic surgery. J Thorac Dis 2018; 10 (Suppl. 08) S931-S946
  • 9 Reeb J, Olland A, Renaud S. et al. Vascular access for extracorporeal life support: tips and tricks. J Thorac Dis 2016; 8 (Suppl. 04) S353-S363
  • 10 Broman LM, Malfertheiner MV, Montisci A, Pappalardo F. Weaning from veno-venous extracorporeal membrane oxygenation: how I do it. J Thorac Dis 2018; 10 (Suppl. 05) S692-S697
  • 11 Corona in Sachsen. Accessed April 30, 2021, at:
  • 12 Corona Dashboard Dresden. Accessed April 30, 2021, at:
  • 13 Moriwaki Y, Toyoda H, Harunari N. et al. Gauze packing as damage control for uncontrollable haemorrhage in severe thoracic trauma. Ann R Coll Surg Engl 2013; 95 (01) 20-25
  • 14 Geraci TC, Narula N, Smith DE, Moreira AL, Kon ZN, Chang SH. Lobectomy for hemorrhagic lobar infarction in a patient with COVID-19. Ann Thorac Surg 2021; 111 (03) e183-e184
  • 15 Raíces M, Theaux J, Montagne J, Dietrich A. [Emergency pulmonary lobectomy in a patient with severe hemoptisis due to COVID-19]. Medicina (B Aires) 2021; 81 (06) 1048-1051
  • 16 Sromicki J, Schmiady M, Maisano F, Mestres CA. ECMO therapy in COVID-19: an experience from Zurich. J Card Surg 2021; 36 (05) 1707-1712
  • 17 Jacobs JP, Stammers AH, Louis JS. et al. Multi-institutional analysis of 100 consecutive patients with COVID-19 and severe pulmonary compromise treated with extracorporeal membrane oxygenation: outcomes and trends over time. ASAIO J 2021; 67 (05) 496-502
  • 18 Russ M, Menk M, Graw JA. et al. COVID-19 patients require prolonged extracorporeal membrane oxygenation support for survival compared with non-COVID-19 patients. Crit Care Explor 2022; 4 (04) e0671
  • 19 Smith DE, Chang SH, Geraci TC. et al. One-year-outcomes with venovenous extracorporeal membrane oxygenation support for severe COVID-19. Ann Thorac Surg 2022; 114 (01) 70-75
  • 20 Riera J, Alcántara S, Bonilla C. et al. Risk factors for mortality in patients with COVID-19 needing extracorporeal respiratory support. Eur Respir J 2022; 59 (02) 2102463
  • 21 Friedrichson B, Kloka JA, Neef V. et al. Extracorporeal membrane oxygenation in coronavirus disease 2019: a nationwide cohort analysis of 4279 runs from Germany. Eur J Anaesthesiol 2022; 39 (05) 445-451
  • 22 Saeed O, Silvestry S. Extracorporeal membrane oxygenation support during the coronavirus disease 2019 pandemic: outcomes and technical considerations. JTCVS Open 2021; 8: 77-82
  • 23 Morens DM, Taubenberger JK, Fauci AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis 2008; 198 (07) 962-970
  • 24 Scott SJ, Pfotenhauer B, Weiner JJ, Hilleshiem J, Khubbar M, Bhattacharyya S. Respiratory pathogen coinfections in SARS-CoV-2-positive patients in southeastern Wisconsin: a retrospective analysis. Microbiol Spectr 2021; 9 (02) e0083121
  • 25 Moreno-García E, Puerta-Alcalde P, Letona L. et al; COVID-19-researcher group. Bacterial co-infection at hospital admission in patients with COVID-19. Int J Infect Dis 2022; 118: 197-202
  • 26 Nebreda-Mayoral T, Miguel-Gómez MA, March-Rosselló GA. et al. Bacterial/fungal infection in hospitalized patients with COVID-19 in a tertiary hospital in the Community of Castilla y León, Spain. Enferm Infecc Microbiol Clin (Engl Ed) 2020; 40 (04) 158-165
  • 27 Sreenath K, Batra P, Vinayaraj EV. et al. Coninfections with other respiratory pathogens among patients with COVID-19. Microbiol Spectr 2021; 9 (01) e0016321
  • 28 Paparoupa M, Aldemyati R, Roggenkamp H. et al. The prevalence of early- and late-onset bacterial, viral, and fungal respiratory superinfections in invasively ventilated COVID-19 patients. J Med Virol 2022; 94 (05) 1920-1925
  • 29 Schweigert M, Solymosi N, Dubecz A. et al. Predictors of outcome in modern surgery for lung abscess. Thorac Cardiovasc Surg 2017; 65 (07) 535-541
  • 30 Schweigert M, Dubecz A, Giraldo Ospina CF. et al. Use of extracorporeal membrane oxygenation in non-elective major thoracic surgery for infectious lung abscess. Eur J Cardiothorac Surg 2022; 62 (04) ezac116