1
|
Bozer J, Vess A, Pineda P, Essandoh M, Whitson BA, Seim N, Bhandary S, Awad H. Venovenous Extracorporeal Membrane Oxygenation for a Difficult Airway Situation-A Recommendation for Updating the American Society of Anesthesiologists' 'Difficult Airway Algorithm'. J Cardiothorac Vasc Anesth 2023; 37:2646-2656. [PMID: 37211518 DOI: 10.1053/j.jvca.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Jordan Bozer
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Andrew Vess
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Pedro Pineda
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Bryan A Whitson
- Department of Cardiac Surgery, The Ohio State Wexner Medical Center, Columbus, OH
| | - Nolan Seim
- Department of Otolaryngology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Sujatha Bhandary
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Hamdy Awad
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH.
| |
Collapse
|
2
|
Shaller BD, Filsoof D, Pineda JM, Gildea TR. Malignant Central Airway Obstruction: What's New? Semin Respir Crit Care Med 2022; 43:512-529. [PMID: 35654419 DOI: 10.1055/s-0042-1748187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and limited when compared with other branches of interventional pulmonary medicine (e.g., the early diagnosis of peripheral lung nodules). Indeed, one pragmatic, albeit somewhat uncharitable, reading of this article's title might suggest a wry smile and shug of the shoulders as to imply that relatively little has changed in recent years. That said, the spectrum of interventions for MCAO continues to expand, even if at a less impressive clip. Herein, we present on MCAO and its endoscopic and nonendoscopic management-that which is old, that which is new, and that which is still on the horizon.
Collapse
Affiliation(s)
- Brian D Shaller
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Darius Filsoof
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Jorge M Pineda
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | | |
Collapse
|
3
|
Oyake M, Suenobu S, Miyawaki M, Ohchi Y, Ihara K. Airway Emergencies Due to Anterior Mediastinal T-Lymphoblastic Lymphoma Managed With Planned Extracorporeal Membrane Oxygenation and Endotracheal Stent: A Case Report and Literature Review. Cureus 2022; 14:e21799. [PMID: 35261827 PMCID: PMC8892228 DOI: 10.7759/cureus.21799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/27/2022] Open
Abstract
Anterior mediastinal tumors can occasionally cause acute respiratory failure by compressing the trachea and bronchi. In such cases, sedative muscle relaxants during tracheal intubation can cause fatal complete tracheal obstruction. We encountered a 15-year-old male patient with T-lymphoblastic lymphoma (T-LBL) of the anterior mediastinum. For his airway emergency due to the stenosis extended from the lower part of the trachea to the tracheal bifurcation, venovenous (VV) extracorporeal membrane oxygenation (ECMO) was introduced from the femoral vein under local anesthesia. After a short period of tracheal intubation management, an endotracheal stent (ES) was immediately placed in the lower trachea. We performed a needle biopsy, and he was diagnosed with T-LBL. Following the diagnosis, chemotherapy was introduced. The ES was able to secure sufficient tracheal diameter, and ECMO and ventilation were promptly discontinued. In the case of tracheal stenosis from the lower part of the trachea due to anterior mediastinal tumor, depending on the degree of stenosis, VV ECMO can be considered. Moreover, ES can lead to early weaning from VV ECMO and a ventilator.
Collapse
|
4
|
Leow L, Sampath HK, Yong KJ, Kofidis T, Tam JKC, MacLaren G, Teo L, Mithiran H, Ramanathan K. Rescue extracorporeal membrane oxygenation for massive anterior mediastinal masses. J Artif Organs 2021; 24:450-457. [PMID: 33811592 PMCID: PMC8019298 DOI: 10.1007/s10047-021-01264-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
The management of massive anterior mediastinal masses (AMM) is challenging. With the burgeoning role of extracorporeal membrane oxygenation support (ECMO) beyond the confines of salvage therapy, more trained clinicians are adopting it as a bridge for high-risk procedures or situations where temporary respiratory or cardiac support is required. We report our experience with using ECMO in the management of massive AMM in this case series of three patients sharing their clinical details and the lessons learned from them.
Collapse
Affiliation(s)
- Lowell Leow
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Hari Kumar Sampath
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Keith J Yong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - John Kit Chung Tam
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Graeme MacLaren
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Lynette Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Harish Mithiran
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Kollengode Ramanathan
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| |
Collapse
|
5
|
Ramanathan K, Leow L, Mithiran H. ECMO and adult mediastinal masses. Indian J Thorac Cardiovasc Surg 2021; 37:338-343. [PMID: 33967453 DOI: 10.1007/s12055-020-01077-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
The role of extracorporeal membrane oxygenation (ECMO) is expanding as surgeons look at its utility beyond rescue treatment and have started adopting it for high-risk procedures to provide temporary airway and hemodynamic stabilization. ECMO needs to be deliberated in all patients with mediastinal masses who have compromised airways as well as in those with compression of heart and great vessels. There is a dearth of literature highlighting the definitive role of ECMO in patients with mediastinal masses. This article reviews the available adult literature and highlights the possible situations where the use of ECMO would be supportive in the management of patients with mediastinal masses.
Collapse
Affiliation(s)
- Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, National University Heart Centre, Singapore, Singapore.,Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228 Singapore
| | - Lowell Leow
- Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228 Singapore.,Division of Thoracic Surgery, National University Heart Centre, Kent Ridge Rd, Singapore, Singapore
| | - Harish Mithiran
- Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228 Singapore.,Division of Thoracic Surgery, National University Heart Centre, Kent Ridge Rd, Singapore, Singapore
| |
Collapse
|
6
|
Foong TW, Ramanathan K, Chan KKM, MacLaren G. Extracorporeal Membrane Oxygenation During Adult Noncardiac Surgery and Perioperative Emergencies: A Narrative Review. J Cardiothorac Vasc Anesth 2020; 35:281-297. [PMID: 32144062 DOI: 10.1053/j.jvca.2020.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 12/17/2022]
Abstract
Over the last decade, the use of extracorporeal membrane oxygenation (ECMO) has increased significantly. In some centers, ECMO has been deployed to manage perioperative emergencies and plays a role in facilitating high-risk thoracic, airway, and trauma surgery, which may not be feasible without ECMO support. General anesthesiologists who usually manage these cases may not be familiar with the initiation and management of patients on ECMO. This review discusses the use of ECMO in the operating room for thoracic, airway, and trauma surgery, as well as obstetric and perioperative emergencies.
Collapse
Affiliation(s)
- Theng Wai Foong
- Department of Anesthesia and Surgical Intensive Care Unit, National University Hospital, Singapore.
| | - Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore
| | - Kevin Kien Man Chan
- Department of Anesthesia and Surgical Intensive Care Unit, National University Hospital, Singapore
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore
| |
Collapse
|
7
|
Ahn HJ, Lee JW, Ryu S, Cho YC, Jeong WJ. Refractory hypoxemic respiratory failure from metal fume inhalation: Emergency department procedures. Am J Emerg Med 2016; 35:809.e1-809.e3. [PMID: 28017465 DOI: 10.1016/j.ajem.2016.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/11/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hong Joon Ahn
- Surgical ICU, Chungnam National University Hospital, Daejeon, South Korea
| | - Jun Wan Lee
- Emergency ICU, Regional Emergency Center, Chungnam National University Hospital, Daejeon, South Korea.
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Yong Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Won Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| |
Collapse
|
8
|
Choi WJ, Kim YH, Mok JM, Choi SI, Kim HS. Patient repositioning and the amelioration of airway obstruction by an anterior mediastinal tumor during general anesthesia -A case report-. Korean J Anesthesiol 2010; 59:206-9. [PMID: 20877707 PMCID: PMC2946040 DOI: 10.4097/kjae.2010.59.3.206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 11/13/2009] [Accepted: 11/26/2009] [Indexed: 11/10/2022] Open
Abstract
An 18-year-old male with huge anterior mediastinum mass was scheduled for thoracotomic incisional biopsy under general anesthesia after failed fluoroscopy-guided percutaneous needle biopsy. Under propofol and succinylcholine anesthesia, intubation was successfully achieved using a Univent tube. However, when we changed the patient's position from supine to right lateral decubitus, oxygen saturation declined. He was then positioned supine, but hypoxemia did not improve. Because the tumor expanded toward the left thoracic field, we considered that the left lateral decubitus position might help relieve the mass effect on the main bronchus. His position was changed accordingly and soon after, hypoxemia improved and surgery was undertaken under cardiopulmonary bypass (CPB). The biopsy was successfully performed under CPB without complication.
Collapse
Affiliation(s)
- Won Joon Choi
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
9
|
Soon JL, Poopalalingam R, Lim CH, Koong HN, Agasthian T. Peripheral Cardiopulmonary Bypass–Assisted Thymoma Resection. J Cardiothorac Vasc Anesth 2007; 21:867-9. [DOI: 10.1053/j.jvca.2006.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Indexed: 11/11/2022]
|