Use of Venovenous Extracorporeal Membrane Oxygenation Under Regional Anesthesia for a High-Risk Rigid Bronchoscopy

Gourdin, Maximilien; Dransart, Christophe; Delaunois, Luc; Louagie, Yves; Gruslin, André; Dubois, Philippe

doi:10.1053/j.jvca.2011.02.013

Cited by 24 publications

(11 citation statements)

References 9 publications

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“…Venovenous extracorporeal membrane oxygenation (VV ECMO) is used not only to support ventilation of patients suffering from respiratory failure (8)(9)(10)(11)(12)(13), but also to manage hypoxic patients with critical airway obstruction during various procedures, such as stent placement and removal, rigid bronchoscopy, or pediatric surgery (6-9,14-16). However, previous reports focusing on stent placement under respiratory support with VV ECMO have been limited to case reports or very small series (6,7,14,15).…”

Section: Introductionmentioning

confidence: 99%

Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis

et al. 2017

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Background: Venovenous extracorporeal membrane oxygenation (VV ECMO) is used to support gas transfer of patients suffering from respiratory failure during various procedures. The purpose of this study was to evaluate the technical feasibility and safety of fluoroscopic stent placement under respiratory support with VV ECMO in patients with critical airway obstructions. Methods:We reviewed the records of 17 patients (14 male and 3 female; mean age: 63 years; range, 30-82 years) who underwent self-expandable metallic stent (SEMS) placement under VV ECMO respiratory support for critical airway obstruction caused by malignant (n=16) or benign (n=1) etiology.Results: Fluoroscopic placement of SEMS was successful in all patients (100%) with no procedure-related complications. During a mean follow-up of 83 days (range, 10-367 days), 15 (88.2%) of 17 patients showed improvement of Hugh-Jones grades (from 4.7±0.4 to 3.1±0.9, P<0.001). Removal of the endotracheal tube was possible in 11 (84.6%) of 13 patients. Weaning off ECMO was successful in all patients. The ECMOrelated and stent-related complication rates were 11.7% (n=2) and 29.4% (n=5), respectively, all successfully managed by additional interventions. Indications for VV ECMO included failure of mechanical ventilation in 13 (76.5%) patients, and orthopnea in 4 (23.5%) patients.Conclusions: Fluoroscopic stent placement under VV ECMO respiratory support can be successfully performed in patients with critical airway obstruction, especially in cases of respiratory distress despite ventilation support and an inability to lie in a supine position. However, further studies will be needed to validate the standardized methods and specific indications.

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Section: Introductionmentioning

confidence: 99%

Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis

et al. 2017

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“…VV-ECMO has a low risk of neurological complications, compared to VA-ECMO, improves myocardial perfusion, and allows for normal, pulsatile arterial blood flow. [3] While others have described VV-ECMO cannulation through the right internal jugular vein and right femoral vein, we feel that bilateral femoral venous cannulation is less invasive, allows for better airway access, achieves equivalent right heart drainage, and is preferred if the patient’s vessel size will accommodate it. Because of the repeated cannulation of femoral arteries with large bore catheters, we performed serial ultrasound examinations to evaluate for vascular complications.…”

Section: Discussionmentioning

confidence: 95%

“…[6] We agree with previous reports emphasizing the need to verify cannula placement prior to ECMO initiation and utilized a TEE probe in this case. [3]…”

Section: Discussionmentioning

confidence: 99%

“…The first case utilized VV-ECMO preemptively for removal of a tracheal stent because extraction was likely to cause complete airway obstruction. [3] The next two cases involved inoperable tracheal stenosis requiring ECMO for stent placement. [7] The final patient underwent tracheal stent replacement, but during the procedure the metal frame of the stent twisted resulting in near complete airway obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…[1] However, in some patients with severe TBM, airway collapse may prohibitively limit the ability to oxygenate and ventilate patients undergoing complex tracheobronchial intervention. [3] We report a case of severe TBM requiring the use of veno-venous extracorporeal membrane oxygenation(VV-ECMO) to provide adequate respiratory support during rigid bronchoscopy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Respiratory Support With Venovenous Extracorporeal Membrane Oxygenation During Stenting of Tracheobronchomalacia

George

Knudsen

Sodha

et al. 2012

The Annals of Thoracic Surgery

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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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Use of Venovenous Extracorporeal Membrane Oxygenation Under Regional Anesthesia for a High-Risk Rigid Bronchoscopy

Cited by 24 publications

References 9 publications

Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis

Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis

Respiratory Support With Venovenous Extracorporeal Membrane Oxygenation During Stenting of Tracheobronchomalacia

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

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