Use of Extracorporeal Membrane Oxygenation for Major Cardiopulmonary Resections

Abstract

Background In thoracic surgery, utilization of extracorporeal membrane oxygenation (ECMO) is mainly established for patients undergoing lung transplantation. The aim of our study was to summarize our single-center experience with intraoperative use of veno-venous- or veno-arterial-ECMO in patients undergoing complex lung surgery involving the main carina, or the left atrium or the descending aorta. Methods A total of 24 patients underwent combined complex lung, carinal, aortal, or left atrial resections. In cases of carinal resection, percutaneous veno-venous, jugular–femoral cannulation was considered suitable. For combined resection of lung and descending aorta, a percutaneous femoral veno-arterial cannulation was used. In cases of extended left atrial resection, a percutaneous jugular–femoral veno-venous-arterial cannulation was favored. Results Procedures were divided into three groups: carinal resections and reconstruction (n = 8), resections of the descending aorta and left lung (n = 7), resections of lung and left atrium (n = 9). No intraoperative complications occurred. Overall 30-day mortality was 25%. A complete resection was achieved in 18 patients. Median survival was 12 months. One- and 5-year survival were 48.1 and 22.7%, respectively. Conclusion The present study shows that intraoperative use of ECMO for extended carinal, aortic, or atrial resections is feasible with minimal intraoperative complications allowing surgeons increased operating-field safety. Perioperative mortality is high, but this is rather an attribute of local extended disease and patient comorbidities.

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

“…The intraoperative use of VV or VA ECMO in patients undergoing elective, complex thoracic surgery involving the main airway, the heart or the aorta has been reported in various case reports and feasibility studies. These patients suffer from an increased morbidity and mortality rate, which might be rather an attribute of the local advanced disease and the patients` comorbidities (36). But there are also indications for non-elective thoracic surgery procedures in patients while on ECMO support, especially during mid-and long-term support with well-known potential complications (13).…”

Extracorporeal membrane oxygenation support in oncological thoracic surgery

“…In the first group of patients, a V-A ECMO was the chosen ECLS support in estimating challenging cases with a setting for partial circulatory support (50% of the cardiac output) during longer periods of aortic clamping. Otherwise, in cases of left atrial tumor infiltration, a VV-A-ECMO setting for total circulatory support was the adopted strategy during surgery (24).…”

Venovenous extracorporeal membrane oxygenation-assisted tracheobronchial surgery: a retrospective analysis and literature review

“…For patients with normal right ventricular function, VV-ECMO is preferred, as it avoids the need for median sternotomy, causes less heparinization than a cardiopulmonary bypass, and has a lower risk of arterial cannulation-related complications, including bleeding, ischemia, and embolism, compared with VA-ECMO (6). In addition to its application in lung transplantation, intraoperative ECMO has been shown to ensure adequate oxygenation and optimal surgical exposure, especially in situations where single-lung ventilation is insufficient to maintain oxygen saturation (7,8).…”