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Schoeberl AK, Staudacher D, Kawashima M, Fischer C, Cypel M, Buchtele N, Staudinger T, Aigner C, Hoetzenecker K, Schweiger T. Alternative venous access sites for dual-lumen extracorporeal membrane oxygenation cannulation. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae060. [PMID: 38603626 PMCID: PMC11031355 DOI: 10.1093/icvts/ivae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 04/10/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Dual-lumen cannulas for veno-venous (VV) extracorporeal membrane oxygenation (ECMO) support are typically inserted in the right internal jugular vein (RIJV); however, some scenarios can make this venous route inaccessible. This multicentre case series aims to evaluate if single-site cannulation using an alternative venous access is safe and feasible in patients with an inaccessible RIJV. METHODS We performed a multi-institutional retrospective analysis including high-volume ECMO centres with substantial experience in dual-lumen cannulation (DLC) (defined as >10 DLC per year). Three centres [Freiburg (Germany), Toronto (Canada) and Vienna (Austria)] agreed to share their data, including baseline characteristics, technical ECMO and cannulation data as well as complications related to ECMO cannulation and outcome. RESULTS A total of 20 patients received alternative DLC for respiratory failure. Cannula insertion sites included the left internal jugular vein (n = 5), the right (n = 7) or left (n = 3) subclavian vein and the right (n = 4) or left (n = 1) femoral vein. The median cannula size was 26 (19-28) French. The median initial target ECMO flow was 2.9 (1.8-3.1) l/min and corresponded with used cannula size and estimated cardiac output. No procedural complications were reported during cannulation and median ECMO runtime was 15 (9-22) days. Ten patients were successfully bridged to lung transplantation (n = 5) or lung recovery (n = 5). Ten patients died during or after ECMO support. CONCLUSIONS Alternative venous access sites for single-site dual-lumen catheters are a safe and feasible option to provide veno-venous ECMO support to patients with inaccessible RIJV.
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Affiliation(s)
- Armin-Kai Schoeberl
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty Johannes Kepler University Linz, Linz, Austria
| | - Dawid Staudacher
- Department of Intensive Care Medicine, University of Freiburg, Freiburg, Germany
| | - Mitsuaki Kawashima
- Department of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Courtney Fischer
- Department of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Marcelo Cypel
- Department of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Nina Buchtele
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
| | - Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Wang XF, Li ZY, Chen L, Chen LX, Xie F, Luo HQ. Anesthesia for extracorporeal membrane oxygenation-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung: A case report. World J Clin Cases 2023; 11:4368-4376. [PMID: 37449220 PMCID: PMC10336995 DOI: 10.12998/wjcc.v11.i18.4368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND It is difficult and risky for patients with a single lung to undergo thoracoscopic segmental pneumonectomy, and previous reports of related cases are rare. We introduce anesthesia for Extracorporeal membrane oxygenation (ECMO)-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung.
CASE SUMMARY The patient underwent comprehensive treatment for synovial sarcoma of the right lung and nodules in the lower lobe of the left lung. Examination showed pulmonary function that had severe restrictive ventilation disorder, forced expiratory volume in 1 second of 0.72 L (27.8%), forced vital capacity of 1.0 L (33%), and maximal voluntary ventilation of 33.9 L (35.5%). Lung computed tomography showed a nodular shadow in the lower lobe of the left lung, and lung metastasis was considered. After multidisciplinary consultation and adequate preoperative preparation, thoracoscopic left lower lung lobe S9bii+S10bii combined subsegmental resection was performed with the assistance of total intravenous anesthesia and ECMO intraoperative pulmonary protective ventilation. The patient received postoperative ICU supportive care. After surgical treatment, the patient was successfully withdrawn from ECMO on postoperative Day 1. The tracheal tube was removed on postoperative Day 4, and she was discharged from the hospital on postoperative Day 15.
CONCLUSION The multi-disciplinary treatment provided maximum medical optimization for surgical anesthesia and veno-venous ECMO which provided adequate protection for the patient's perioperative treatment.
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Affiliation(s)
- Xiang-Feng Wang
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Zi-Yan Li
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Lei Chen
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Long-Xiang Chen
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Fang Xie
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Hui-Qin Luo
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
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3
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Wang XF, Li ZY, Chen L, Chen LX, Xie F, Luo HQ. Anesthesia for extracorporeal membrane oxygenation-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung: A case report. World J Clin Cases 2023; 11:4368-4376. [DOI: 10.12998/wjcc.v11.i18.4368 wang xf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
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4
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Boisen ML, Fernando RJ, Alfaras-Melainis K, Hoffmann PJ, Kolarczyk LM, Teeter E, Schisler T, Ritchie PJ, La Colla L, Rao VK, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights From 2021. J Cardiothorac Vasc Anesth 2022; 36:4252-4265. [PMID: 36220681 DOI: 10.1053/j.jvca.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Paul J Hoffmann
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter J Ritchie
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Luca La Colla
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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5
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Mangiameli G, Testori A, Cioffi U, Alloisio M, Cariboni U. Extracorporeal membrane oxygenation support in oncological thoracic surgery. Front Oncol 2022; 12:1005929. [PMID: 36505824 PMCID: PMC9732715 DOI: 10.3389/fonc.2022.1005929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022] Open
Abstract
The use of extracorporeal lung support (ECLS) during thoracic surgery is a recent concept that has been gaining increasing approval. Firstly introduced for lung transplantation, this technique is now increasingly adopted also in oncological thoracic surgical procedures. In this review, we focus on the cutting-edge application of extracorporeal membrane oxygenation (ECMO) during oncological thoracic surgery. Therefore, we report the most common surgical procedures in oncological thoracic surgery that can benefit from the use of ECMO. They will be classified and discussed according to the aim of ECMO application. In particular, the use of ECMO is usually limited to certain lung surgery procedures that can be resumed such as in procedures in which an adequate ventilation is not possible such as in single lung patients, procedures where conventional ventilation can cause conflict with the surgical field such as tracheal or carinal surgery, and conventional procedures requiring both ventilators and hemodynamic support. So far, all available evidence comes from centers with large experience in ECMO and major thoracic surgery procedures.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,*Correspondence: Alberto Testori,
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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6
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Suzuki Y, Cass S, Carvalho JL, DeAnda A, Radhakrishnan RS. Extracorporeal Membrane Oxygenation for Patients with Thoracic Neoplasms: An Extracorporeal Life Support Organization (ELSO) Registry Analysis. Ann Thorac Surg 2022; 114:1816-1822. [PMID: 35351418 DOI: 10.1016/j.athoracsur.2022.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Extracorporeal Membrane Oxygenation (ECMO) is utilized in the management of severe cardiopulmonary failure but the indication in the oncologic population has not been clearly established. Among malignancies, thoracic neoplasms are unique in their potential direct impact on cardiopulmonary function. This study aims to better define the role of ECMO for thoracic neoplasms. METHODS The Extracorporeal Life Support Organization registry was queried for patients older than 18 years with an International Classification of Diseases code of thoracic neoplasm over the past two decades (2000-2019). Outcomes and clinical data including associated procedures were analyzed. RESULTS Four hundred ninety-eight patients met inclusion criteria: 34 upper airway, 247 lung, 45 unspecified respiratory tract, 4 pleura, 19 heart, 40 mediastinum, 108 esophagus, and 1 unspecified neoplasm. One hundred ninety-eight patients survived to discharge (39.8%; "survival"). Upper airway neoplasms were associated with better survival (73.5%; p=0.005) while lung neoplasms were associated with worse survival (30.0%; p<0.001) when compared with all adult ECMO runs. Of the 498 cases, 94 (18.9%) were started after thoracic or airway procedures. Favorable survival was associated with tracheal procedures (66.7%, n=9), while poor survival was seen with pneumonectomy (13.3%, n=30), any type of lung resection (23.7%, n=76), and esophageal procedures (21.4%, n=14). CONCLUSIONS The outcome for ECMO among patients with a thoracic neoplasm is variable, depending on clinical factors including tumor subtype and type of associated procedure. Clinicians should continue to focus on individualized patient selection to achieve optimal results.
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Affiliation(s)
- Yota Suzuki
- University of Texas Medical Branch, Department of Surgery
| | - Samuel Cass
- University of Texas Medical Branch, Department of Surgery
| | | | - Abe DeAnda
- University of Texas Medical Branch, Department of Surgery, Division of Cardiothoracic Surgery
| | - Ravi S Radhakrishnan
- University of Texas Medical Branch, Department of Surgery, Division of Pediatric Surgery.
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7
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Huang W, Ye H, Cheng Z, Liao X, Wang L, Li B, Liang Y, Jiang H. Outcomes from the Use of Perioperative Extracorporeal Membrane Oxygenation in Patients Undergoing Thoracic Surgery: An 8-Year Single-Center Experience. Med Sci Monit 2021; 27:e931842. [PMID: 34725316 PMCID: PMC8570047 DOI: 10.12659/msm.931842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) plays an important role in thoracic surgery. This retrospective study from a single center aimed to evaluate patient outcomes from the use of perioperative ECMO in 22 patients undergoing thoracic surgery during an 8-year period. Material/Methods Data were collected retrospectively from 22 patients who received ECMO (veno-arterial and veno-venous ECMO) as perioperative treatment during general thoracic surgery from January 2012 to October 2020. Patients required ECMO due to perioperative cardiopulmonary resuscitation (CPR) (2 cases), perioperative pulmonary embolism (PE) (2 cases), lung transplant (4 cases), undergoing complicated thoracic surgery (5 cases), postoperative acute respiratory distress syndrome (ARDS) (6 cases), and thoracic trauma (3 cases). Results Veno-arterial ECMO was used for circulatory support in 13 cases and veno-venous ECMO was used for respiratory support in 9 cases. The average ECMO support time was 71.6±42.4 h. Twenty patients (90.9%) were successfully decannulated and 17 (77.2%) survived to discharge. Complications included severe hemorrhage (3/22 patients, 13.6%), sepsis (3/22, 13.6%), and destruction of blood cells (1/22, 4.5%). There were no significant differences in survival rates between patients receiving pre- or postoperative ECMO (P=0.135) or between veno-venous ECMO (V-V ECMO) and veno-arterial ECMO (V-A ECMO) (P=0.550). Conclusions The findings from this small retrospective study from a single center showed that perioperative ECMO improved cardiac and respiratory function in patients undergoing thoracic surgery. Optimal results require surgeons to have an understanding of the indications and ability to control the complications of ECMO.
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Affiliation(s)
- Weizhao Huang
- Department of Cardiothoracic Surgery, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan People's Hospital), Zhongshan, Guangdong, China (mainland)
| | - Hongyu Ye
- Department of Cardiothoracic Surgery, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan People's Hospital), Zhongshan, Guangdong, China (mainland)
| | - Zhou Cheng
- Department of Anesthesiology, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan City People's Hospital), Zhongshan, Guangdong, China (mainland)
| | - Xiaozu Liao
- Department of Anesthesiology, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan City People's Hospital), Zhongshan, Guangdong, China (mainland)
| | - Liqiang Wang
- Department of Anesthesiology, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan City People's Hospital), Zhongshan, Guangdong, China (mainland)
| | - Binfei Li
- Department of Anesthesiology, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan City People's Hospital), Zhongshan, Guangdong, China (mainland)
| | - Yi Liang
- Department of Cardiothoracic Surgery, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan People's Hospital), Zhongshan, Guangdong, China (mainland)
| | - Haiming Jiang
- Department of Cardiothoracic Surgery, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan People's Hospital), Zhongshan, Guangdong, China (mainland)
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8
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Zarragoikoetxea I, Pajares A, Moreno I, Porta J, Koller T, Cegarra V, Gonzalez A, Eiras M, Sandoval E, Sarralde J, Quintana-Villamandos B, Vicente Guillén R. Documento de consenso SEDAR/SECCE sobre el manejo de ECMO. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Ankeny D, Chitilian H, Bao X. Anesthetic Management for Pulmonary Resection: Current Concepts and Improving Safety of Anesthesia. Thorac Surg Clin 2021; 31:509-517. [PMID: 34696863 DOI: 10.1016/j.thorsurg.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Increasingly complex procedures are routinely performed using minimally invasive approaches, allowing cancers to be resected with short hospital stays, minimal postsurgical discomfort, and improved odds of cancer-free survival. Along with these changes, the focus of anesthetic management for lung resection surgery has expanded from the provision of ideal surgical conditions and safe intraoperative patient care to include preoperative patient training and optimization and postoperative pain management techniques that can impact pulmonary outcomes as well as patient lengths of stay.
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Affiliation(s)
- Daniel Ankeny
- Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Hovig Chitilian
- Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Xiaodong Bao
- Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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10
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Zarragoikoetxea I, Pajares A, Moreno I, Porta J, Koller T, Cegarra V, Gonzalez AI, Eiras M, Sandoval E, Aurelio Sarralde J, Quintana-Villamandos B, Vicente Guillén R. SEDAR/SECCE ECMO management consensus document. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:443-471. [PMID: 34535426 DOI: 10.1016/j.redare.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/14/2020] [Indexed: 06/13/2023]
Abstract
ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial. Despite the evolution of technology in the area of extracorporeal support, morbidity and mortality of these patients continues to be high, and therefore the indication as well as the ECMO removal should be established within a multidisciplinary team with expertise in the area. This consensus document aims to unify medical knowledge and provides recommendations based on both the recent bibliography and the main national ECMO implantation centres experience with the goal of improving comprehensive patient care.
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Affiliation(s)
- I Zarragoikoetxea
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Moreno
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Porta
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - T Koller
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - V Cegarra
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A I Gonzalez
- Servicio de Anestesiología y Reanimación, Hospital Puerta de Hierro, Madrid, Spain
| | - M Eiras
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Santiago, La Coruña, Spain
| | - E Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Aurelio Sarralde
- Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - B Quintana-Villamandos
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Vicente Guillén
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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11
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Faccioli E, Terzi S, Pangoni A, Lomangino I, Rossi S, Lloret A, Cannone G, Marino C, Catelli C, Dell'Amore A. Extracorporeal membrane oxygenation in lung transplantation: Indications, techniques and results. World J Transplant 2021; 11:290-302. [PMID: 34316453 PMCID: PMC8290996 DOI: 10.5500/wjt.v11.i7.290] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/13/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
The use of extracorporeal membrane oxygenation (ECMO) in the field of lung transplantation has rapidly expanded over the past 30 years. It has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative setting. ECMO is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the recipient. For example, patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous (VV) ECMO or peripheral veno-arterial (VA) ECMO in the case of hemodynamic instability. Moreover, in an intra-operative setting, VV ECMO can be maintained or switched to a VA ECMO. The routine use of intra-operative ECMO and its eventual prolongation in the post-operative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion injury. This review will assess the current evidence on the role of ECMO in the different phases of lung transplantation, while analyzing different studies on pre, intra- and post-operative utilization of this extracorporeal support.
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Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Stefano Terzi
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Alessandro Pangoni
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Ivan Lomangino
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Sara Rossi
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Andrea Lloret
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Giorgio Cannone
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Carlotta Marino
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Chiara Catelli
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
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12
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Venoarterial Extracorporeal Membrane Oxygenator Support in Lung Cancer Resection. Ann Thorac Surg 2021; 113:e191-e193. [PMID: 34111383 DOI: 10.1016/j.athoracsur.2021.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022]
Abstract
Cardiovascular comorbidities often prevent patients with otherwise resectable early-stage lung cancer from undergoing surgery due to prohibitive peri-operative risk. Here we describe the first intraoperative use of venoarterial (VA) ECMO in a stage cIIA lung cancer patient with arterial infiltration and severe post-ischemic dilated cardiomyopathy (EF 23%) undergoing left upper lobectomy with pulmonary artery angioplasty. Providing intra-operative cardiovascular and respiratory function support, VA-ECMO represents a suitable option for patients with heart failure, ensuring adequate hemodynamic profile and reducing the risk of complications. These otherwise inoperable patients can thus be offered a potentially curative surgical resection of the malignancy. Surgery is the standard treatment for patients with early-stage lung cancer 1. However, several patients with advanced heart failure may be excluded from surgery due to prohibitive perioperative risk. Providing circulatory and respiratory support, extracorporeal membrane oxygenator (ECMO) may represent a suitable option for such patients 2. While there is a published experience on intraoperative use of veno-venous (VV) ECMO, primarily in thoracic surgery 3, an extremely limited number of reports considered the use of venoarterial (VA)-ECMO in patients undergoing non-cardiac surgery 45. VA-ECMO is currently indicated in patients with cardiovascular failure and concomitant cardiac pump dysfunction, as in post-operative ARDS associated with septic shock 4; outside the intensive care unit, the use of pre-emptive VA-ECMO has traditionally been limited to patients undergoing elective ventricular tachycardia ablation and structural heart procedures5. Here we report the first case of intraoperative use of VA-ECMO in a patient with resectable lung cancer and ischemic heart disease with prohibitive left ventricular function, and describe the benefits of this new indication.
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13
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Bellini A, Dell'Amore A, Ferrigno P, Sella N, Navalesi P, Rea F. ECLS for Life-Threatening Complications in Mesothelioma's Surgery: Is It Worthwhile? Thorac Cardiovasc Surg 2021; 69:548-550. [PMID: 33601471 DOI: 10.1055/s-0041-1724037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Extracorporeal life support (ECLS) is an effective method for bridging patients to recovery in cases of respiratory and/or cardiac failure that are potentially reversible and unresponsive to conventional management. Nevertheless, there have been only few reports about the use of ECLS in oncological patients with complications due to their neoplasm or its treatment. We report the use of veno-arterial extracorporeal membrane oxygenation in three cases of severe perioperative complications following surgery for mesothelioma after induction chemotherapy at our Institution.
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Affiliation(s)
- Alice Bellini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, Padova University Hospital, Padova, Italy
| | - Andrea Dell'Amore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, Padova University Hospital, Padova, Italy
| | - Pia Ferrigno
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, Padova University Hospital, Padova, Italy
| | - Nicolo' Sella
- Department of Medicine - DIMED, Padova University Hospital, Padova, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, Padova University Hospital, Padova, Italy.,Institute of Anesthesia and Intensive Care, Padova University Hospital, Padova, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, Padova University Hospital, Padova, Italy
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