National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation

Rinieri, Philippe; Peillon, Christophe; Bessou, Jean–Paul; Veber, Benoît; Falcoz, Pierre‐Emmanuel; Melki, J.; Baste, Jean-Marc

doi:10.1093/ejcts/ezu127

Cited by 67 publications

(68 citation statements)

References 24 publications

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“…17 This trial reported a significant improvement in the mortality rate without severe disability at six months in patients with severe respiratory disease who were transferred to a specialist centre for consideration for ECMO treatment compared with continued conventional ventilation. Since then, the use of either form of ECMO has been used for a wide range of conditions that require cardiac and/ or respiratory support, 16,18,19 as well as for support during a range of cardiac and thoracic 20 interventions.…”

Section: Guidelinesmentioning

confidence: 99%

The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review

Malpas

Hung

Gilchrist

et al. 2018

Can J Anesth/J Can Anesth

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While extracorporeal membrane oxygenation (ECMO) is an effective method of oxygenation for patients with respiratory failure, further refinement of its incorporation into airway guidelines is needed. We present a case of severe glottic stenosis from advanced thyroid carcinoma in which gas exchange was facilitated by veno-arterial ECMO prior to achieving a definitive airway. We also conducted a systematic review of the MEDLINE, EMBASE, CINAHL, and Web of Science databases, using the keywords "airway/ tracheal obstruction", "anesthesia", "extracorporeal", and "cardiopulmonary bypass" to identify reports where ECMO was initiated as the a priori method of oxygenation during difficult airway management.Thirty-six papers were retrieved discussing the use of ECMO or cardiopulmonary bypass (CPB) for the management of critical airway obstruction. Forty-five patients underwent pre-induction of anesthesia institution of CPB or ECMO for airway obstruction. The patients presenting with critical airway obstruction had a range of airway pathologies with tracheal tumours (31%), tracheal stenosis (20%), and head and neck cancers (20%) being the most common. All cases reported a favourable patient outcome with all patients surviving to hospital discharge without significant complications.While most practitioners are familiar with the fundamental airway techniques of bag-mask ventilation, supraglottic airway use, tracheal intubation, and front-of-neck airway access for oxygenation, these techniques have limitations in managing patients with pre-existing severe airway obstruction. The use of ECMO should be considered in patients with severe (or near-complete) airway obstruction secondary to anterior neck or tracheal disease. This approach can provide essential tissue oxygenation while attempts to secure a definitive airway are carried out in a controlled environment.

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Section: Guidelinesmentioning

confidence: 99%

The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review

Malpas

Hung

Gilchrist

et al. 2018

Can J Anesth/J Can Anesth

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“…Another alternative option described in human medicine is the use of cardiopulmonary bypass. 20 Unfortunately, the necessary equipment and trained personnel are rarely available in veterinary hospitals.…”

Section: Discussionmentioning

confidence: 99%

Airway management for tracheal resection proximal to carina in a cat

Calice¹,

Rocchi²

2019

Vet Record Case Reports

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tracheal tumours in cats are rare, and most primary tumours respond well to complete surgical excision. providing secure airway management during resection of the trachea is particularly challenging and in some cases represents a limitation to surgery. We present the case of a cat with a primary tracheal neoplasm located close to the carina, undergoing complete resection. successful management of the airway was accomplished by intubating the distal tracheal stump with a modified polyvinyl chloride endotracheal tube. effective seal of the airway and adequate ventilation of both lungs were achieved. We describe a reliable, simple, low-cost technique which provides control of the airways even in situations where the distal stump of the trachea is either too short or non-existent.

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“…[8][9][10] Local insertion-site infections (9.7% versus 17 -49%) and cannula-related bleeding requiring surgical revision or blood transfusions (2.8% versus 17%) are less frequently observed compared with conventional double-venous cannulation in VV-ECMO. 4,5,[8][9][10][11] A further, at least theoretical, advantage may be a de-escalation of inflammatory and thrombotic responses; this due to fewer plastic materials being directly inserted into the large veins of the human body. 4,8 Some authors criticize the Avalon ® system in terms of limited blood flow, which may be problematic, in particular, for taller hypoxemic patients.…”

Section: Discussionmentioning

confidence: 99%

Double-stage venous cannulation combined with Avalon® cannula for potential prolongation of respiratory ECMO in end-stage pulmonary disease

et al. 2016

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Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a treatment option to correct blood oxygenation in cases of severe respiratory failure. However, it is time-limited and, in cases of no- recovery, it is a bridge-to-lung transplant therapy. We report our experience of two patients waiting for emergency lung transplantation under VV-ECMO using the Avalon® cannula. Both presented signs of ECMO failure after prolonged support, i.e. increased hemolysis, decreased blood flow rate and increased negative pressure of the venous inflow line, leading to an inadequate systemic oxygenation. The addition of a second venous inflow line, by the insertion of another venous femoral cannula, significantly increased blood flow rate, decreasing both centrifugal pump rotation speed and negative pressure (suction) of the venous inflow line. These hemodynamic improvements, together with reduced blood consumption, were maintained during an additional week of ECMO support. Ultimately, both patients died from multi-organ failure due to the absence of available donor organs. Few cases having been described up until now, but the addition of a second venous drainage cannula to the Avalon® system could potentially improve hemodynamic parameters and, therefore, stabilize hypoxemic patients. This may be an option to gain time in long-lasting VV-ECMO support as a potential life-saving attempt.

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National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation

Cited by 67 publications

References 24 publications

The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review

The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review

Airway management for tracheal resection proximal to carina in a cat

Double-stage venous cannulation combined with Avalon® cannula for potential prolongation of respiratory ECMO in end-stage pulmonary disease

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