Extracorporeal membrane oxygenation is a valuable tool for the general thoracic surgeon

Hintergrund Intraoperative extracorporeal membrane oxygenation (ECMO) enables lung resections that are otherwise impossible or difficult on one-lung ventilation but also improves exposure for complex airway surgery. Outside the transplant setting, ECMO support during surgery is still considered rare. We therefore describe our single-center experience.

Material und Methode We retrospectively reviewed all patients who underwent general thoracic surgical procedure on ECMO support in our center from March 2016 to February 2022.

Ergebnis Nine patients (5 female, 56%) with a median age of 46 years (33 to 71) underwent 9 procedures on ECMO. Indication for intraoperative ECMO was carinal resection and reconstruction in 5 patients (56%), metastasectomy for central lesions in 2 patients (22%) with previous pneumonectomy, and respiratory failure in 2 patients (22%) requiring lung biopsy or tracheal repair. Veno-venous (V-V) ECMO was used in 8 patients (89%) including femoro-femoral and femoro-jugular cannulations in five and three patients, respectively. One patient (11%) had femoro-femoral veno-arterial (V-A) ECMO. Apnea was required in all but one patient (89%). During apnea phases, gas exchanges were fully provided by ECMO support except in one patient who required additional jet ventilation. Systemic heparin was administered in all patients before ECMO insertion. A median of 2 blood units were transfused per patient (0 to 8 units) intraoperatively. ECMO was weaned intraoperatively in 7 patients (78%) and at postoperative day one in one patient (11%) due to bilateral pneumonia. In the last patient (11%) with preoperative respiratory failure and bilateral lung infiltrate of unknown origin, withdrawal of life support was decided after lung biopsy revealed incurable lung adenocarcinoma. No severe ECMO-related postoperative complications or death occurred.

Schlussfolgerung The use of intraoperative ECMO for general thoracic surgical procedures is safe. It is a valuable tool for complex airway surgery or when gas exchange with one-lung ventilation alone is compromised.

 

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Artikel online veröffentlicht:
13. September 2022