Extracorporeal support in airway surgery

Abstract

Extracorporeal life support (ECLS) is increasingly used for major airway surgery. It facilitates complex reconstructions and maintains gas exchange during endoscopic procedures in patients with critical airway obstruction. ECLS offers the advantage of an uncluttered surgical field and eliminates the need for crossing ventilation tubes, thus, making precise surgical dissection easier. ECLS is currently used for hemodynamic and respiratory support in lung transplantation as well as extended tumor resections with an acceptable risk profile. This work reviews the published experience of ECLS in airway surgery both in adults and in pediatric patients. It highlights currently available devices and their indications.

The bridging bronchus: A comprehensive review of a rare, potentially life‐threatening congenital airway anomaly associated with cardiovascular defects

“…In some cases, adequate oxygenation and ventilation may still prove difficult if not impossible given the location (eg, carina involvement) or severity of the stenosis. Moreover, in a high‐risk infant or child, technically difficult intubation or ventilation may result in hypoxia and hypercapnia leading to potential neurologic sequelae . As such, in select patients, cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) may be useful.…”

“…As such, in select patients, cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) may be useful. In addition, heart‐lung bypass may allow for correction of concomitant CHD or great vessel anomalies …”

“…ECMO is gaining popularity as an alternative to CPB for providing intraoperative cardiopulmonary support during lung and airway surgery in infants and children . ECMO has several advantages over CPB.…”

Principles and indications of extracorporeal life support in general thoracic surgery

“…When VV-ECMO provides insufficient oxygenation during tracheal surgery, supplemental catheter oxygen insufflation had also been used (27). ECLS during airway surgery has been recently described in an extensive review (31). While ECLS was noted to facilitate optimal exposure while maintaining oxygenation, this was at the cost of increased bleeding due to heparinization.…”

New era of “resection of the carina and lower trachea”

“…Recently, ECLS has become a valuable and a secure choice for complex surgical cases in patients with near-total occlusion of the airways to support respiratory functions during complex therapy. In fact, we have increasingly used ECLS for major airway surgery, endoscopic airway intervention, acute respiratory failure, lung transplant surgery as well as a bridge to lung transplantation (16)(17)(18)(19). One of the important indications of ECLS in airway management is intense and emergency situations when conventional ventilation procedures are difficult during the surgery.…”