Non-elective thoracic surgery in patients supported by veno-venous (VV) or veno-arterial (VA) extracorporeal membrane oxygenation (ECMO)

Abstract

The application of veno-arterial (VA) or veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is still expanding worldwide in order to treat patients with severe cardiac and/ or respiratory failure. Pulmonary or pleural infections and severe thoracic trauma as some of the leading causes for acute lung failure necessitating VV ECMO might indicate urgent thoracic surgery with the aim to control bleeding, infection and to avoid septic multiorgan failure. Although miniaturized extracorporeal devices are used more common as a temporary support in these patients, concomitant bleeding complications and anticoagulation disorders are well known clinically relevant problems during ECMO support.Thoracic bleeding complications are frequently reported bleeding complications and often require surgical interventions. Non-elective thoracic surgery in patients with VA or VV ECMO warrants strict indications, because these patients have an extensively high perioperative risk profile and often suffer from postoperative complications with the need of surgical revision in approximately 60% of cases. Therefore, ECMO support should be performed whenever possible in specialised centers with an all-time available thoracic surgeon who has surgical experience in these jeopardised patients. The indication and optimal time for thoracic surgery as well as the perioperative management (coagulation management, ventilation, weaning, re-operations) should always be determined in an interdisciplinary setting.