Venovenous extracorporeal membrane oxygenation during high-risk airway interventions

Abstract

OBJECTIVES Practice patterns for the use of extracorporeal membrane oxygenation (ECMO) during high-risk airway interventions vary, and data are limited. We aim to characterize our recent experience using ECMO for procedural support during whole-lung lavage (WLL) and high-risk bronchoscopy for central airway obstruction (CAO). METHODS We performed a retrospective cohort study of adults who received ECMO during WLL and high-risk bronchoscopy from 1 July 2018 to 30 March 2020. Our primary end point was successful completion of the intervention. Secondary end points included ECMO-associated complications and hospital survival. RESULTS Eight patients received venovenous ECMO for respiratory support during 9 interventions; 3 WLLs for pulmonary alveolar proteinosis were performed in 2 patients, and 6 patients underwent 6 bronchoscopic interventions for CAO. We initiated ECMO prior to the intervention in 8 cases and during the intervention in 1 case for respiratory decompensation. All 9 interventions were successfully completed. Median ECMO duration was 17.8 h (interquartile range, 15.9–26.6) for the pulmonary alveolar proteinosis group and 1.9 h (interquartile range, 1.4–8.1) for the CAO group. There was 1 cannula-associated deep vein thrombosis; there were no other ECMO complications. Seven patients (87.5%) and 4 (50.0%) patients survived to discharge and 1 year postintervention, respectively. CONCLUSIONS Use of venovenous ECMO to facilitate high-risk airway interventions is safe and feasible. Planned preprocedural ECMO initiation may prevent avoidable respiratory emergencies and extend therapeutic airway interventions to patients otherwise considered too high risk to treat. Guidelines are needed to inform the utilization of ECMO during high-risk bronchoscopy and other airway interventions.

Early ECMO Initiation as a Bridge for Central Airway Obstruction Patients Caused by Neck and Chest Tumors to Emergency Surgery Operations

“…In recent years, the stent placement as an interventional treatment to palliate the critical airway obstruction caused by tumor is becoming widely accepted [7,8,[10][11][12]. Because stent placement is safe, minimally invasive, well tolerated, and is increasingly used in various benign and malignant conditions characterized by central airway stenosis [13,14,26,28]. However, stent placement also have defects, for example, it can increase the risk of major bleeding or complete bilateral obstruction of the main bronchus [29].…”

“…Immediately, we used early ECMO to manage di cult airway and support surgical procedure in ED. Previous clinical studies presented that use ECMO to ensure adequate ventilatory function (CO 2 removal and oxygenation) in stent placement and bronchoscopy for patients with critical airway obstruction [13,14,28]. Their starting time of ECMO was intraoperative, and mainly solved the problem of intraoperative hypoxia.…”

“…The most common cause of central airway obstruction are direct compression and extension from the adjacent tumor [11,12]. Providing effective airway managements, adequate ventilatory (CO 2 removal and oxygenation) and emergency surgical interventions can play a signi cant role in such patients [13,14].…”

Early ECMO Initiation as a Bridge for Central Airway Obstruction Patients Caused by Neck and Chest Tumors to Emergency Surgery Operations

“…In brief, VV ECMO, cannulation site from femoral vein to internal jugular vein (or subclavian vein), was preferred for respiratory failure in thoracic surgeries. Previous studies have shown that VV ECMO can help to ensure adequate ventilatory function (CO 2 removal and oxygenation) when performing stent placement in patients with central airway obstruction [13,14,28]. VV ECMO can provide time to plan and implement adequate treatment, thereby minimizing procedure-related complications [28].…”

Extracorporeal Membrane Oxygenation: Beyond Conventional Indications

“…Currently, ECMO is deployed electively to mitigate the risk and ensure the safe and successful performance of high-risk procedures in at-risk patients. Elective initiation of ECMO has been associated with better outcomes than emergent rescue placement in the setting of cardiopulmonary arrest [4]. Further, by anticipating operative risks, a multidisciplinary team can decide on and prepare the most appropriate ECMO modality to provide support if needed.…”