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Slama A, Stork T, Collaud S, Aigner C. Current use of extracorporeal life support in airway surgery: a narrative review. J Thorac Dis 2023; 15:4101-4110. [PMID: 37559597 PMCID: PMC10407487 DOI: 10.21037/jtd-22-1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Extracorporeal life support (ECLS) is widely used in patients with severe respiratory or cardiocirculatory failure. The most commonly used extracorporeal membrane oxygenation (ECMO) modes are veno-venous (V-V) and veno-arterial (V-A) ECMO, which can both be achieved by various types of vascular cannulation. Within the scope of tracheobronchial surgery, intraoperative ECLS may occasionally be necessary to provide sufficient oxygenation to a patient throughout a procedure, especially when conventional ventilation strategies are limited. Additionally, V-A ECMO can provide cardiopulmonary support in emergencies and in cases where hemodynamic instability can occur. METHODS This narrative literature review was carried out to identify the use and the specifics of ECLS in airway surgery over the last years. Data from 168 cases were summarized according to the indication for surgery and the mode of ECLS (V-V, V-A). KEY CONTENT AND FINDINGS The most common tracheobronchial pathologies in which support was needed were: primary malignant disease of the airways, malignant infiltration, tracheal stenosis, injury of the airway, and congenital airway disease. With increasing experience in ECLS, the number of reported cases performed with intraoperative ECLS increased steadily over the last decade. CONCLUSIONS A trend favoring the use of V-V ECMO over V-A ECMO was identified. These approaches should now be considered indispensable tools for managing challenging surgical cases.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery, University Medicine Essen, Ruhrlandklinik, Essen, Germany
- Department of Thoracic Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, University Medicine Essen, Ruhrlandklinik, Essen, Germany
- Department of Thoracic Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Stephane Collaud
- Department of Thoracic Surgery, University Medicine Essen, Ruhrlandklinik, Essen, Germany
- Department of Thoracic Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University Medicine Essen, Ruhrlandklinik, Essen, Germany
- Department of Thoracic Surgery, Klinik Floridsdorf, Vienna, Austria
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Petrella F, Zorzino L, Frassoni S, Bagnardi V, Casiraghi M, Bardoni C, Mohamed S, Musso V, Simonini E, Rossi F, Alamanni F, Venturino M, Spaggiari L. Intraoperative Extra Corporeal Membrane Oxygenator for Lung Cancer Resections Does Not Impact Circulating Tumor Cells. Cancers (Basel) 2022; 14:cancers14205004. [PMID: 36291788 PMCID: PMC9599645 DOI: 10.3390/cancers14205004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The diagnosis of active neoplastic disease was traditionally judged an absolute contraindication for extracorporeal membrane oxygenator (ECMO) because of long-term results uncertainty and co-existing acquired coagulation disorders often diagnosed in this group of patients. There is a growing body of evidence that circulating tumor cells (CTCs) can be detected in the blood of patients before the primary tumor is diagnosed and in the case of carcinoma recurrence; moreover, on some occasions, they persist in the blood of patients after radical resection of the primary tumor. The aim of this prospective, two-arm study is to compare the number of CTCs before and after surgery in patients undergoing lung cancer resection with and without intraoperative ECMO support. Intraoperative ECMO for lung cancer resections did not impact CTC variation after the procedure and did not impact postoperative complications, ICU stay, hospital total length of stay, and post operative C-reactive protein increase. Abstract Background: The diagnosis of active neoplastic disease was traditionally judged an absolute contraindication for extracorporeal membrane oxygenator (ECMO) because of the fear of tumor cells being scattered or seeded. The aim of this study is to compare the number of circulating tumor cells (CTCs) before and after surgery in patients receiving lung cancer resection with and without intraoperative ECMO support. Methods: This is a prospective, non-randomized, two-arms observational study comparing the number of CTCs before and after surgery in patients receiving lung cancer resection with and without intraoperative ECMO support. The ECMO arm includes patients suffering from lung cancer undergoing pulmonary resection with planned intraoperative ECMO support. The non-ECMO arm includes patients suffering from non-early-stage lung cancer undergoing pulmonary resection without planned intraoperative ECMO support. Results: Twenty patients entered the study, eight in the ECMO arm and twelve in the non-ECMO arm. We did not observe any significant difference between the ECMO and non-ECMO groups in terms of postoperative complications (p = 1.00), ICU stay (p = 0.30), hospital stay (p = 0.23), circulating tumor cells’ increase or decrease after surgery (p = 0.24), and postoperative C-reactive protein and C-reactive protein increase (p = 0.80). The procedures in the non-ECMO arm were significantly longer than those in the ECMO arm (p = 0.043). Conclusions: Intraoperative ECMO for lung cancer resections did not impact CTC increase or decrease after the procedure.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Correspondence: or ; Tel.: +39-0257-489-362; Fax: +39-0294-379-218
| | - Laura Zorzino
- Division of Laboratory Medicine, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Claudia Bardoni
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Shehab Mohamed
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Valeria Musso
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Emanuele Simonini
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Fabiana Rossi
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20138 Milan, Italy
| | - Francesco Alamanni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- IRCCS Galeazzi Sant’Ambrogio, Cardiochirurgia Universitaria, 20157 Milan, Italy
| | - Marco Venturino
- Department of Anesthesiology, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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3
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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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Signore F, Brascia D, Schiavone M, De Iaco G, Panza T, De Palma A, Murgolo F, Civita A, Di Mussi R, Grasso S, Marulli G. Case Report: Inferior Bilobectomy for Lung Cancer to Allow Weaning From Veno-Venous Extracorporeal Membrane Oxygenation. Front Surg 2021; 8:736541. [PMID: 34621780 PMCID: PMC8491835 DOI: 10.3389/fsurg.2021.736541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
In recent years, veno-venous extracorporeal membrane oxygenation (V-V ECMO) has allowed complex lung and airways resections in patients with a compromised perioperative respiratory function. In the following report, we present a case of successful weaning from V-V ECMO in a patient who underwent an inferior bilobectomy for lung cancer.
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Affiliation(s)
- Francesca Signore
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Marcella Schiavone
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Giulia De Iaco
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Teodora Panza
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Angela De Palma
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Francesco Murgolo
- Anesthesia and Intensive Care Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Antonio Civita
- Anesthesia and Intensive Care Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Rosa Di Mussi
- Anesthesia and Intensive Care Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Salvatore Grasso
- Anesthesia and Intensive Care Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
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5
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Suk P, Šrámek V, Čundrle I. Extracorporeal Membrane Oxygenation Use in Thoracic Surgery. MEMBRANES 2021; 11:membranes11060416. [PMID: 34072713 PMCID: PMC8227574 DOI: 10.3390/membranes11060416] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022]
Abstract
This narrative review is focused on the application of extracorporeal membrane oxygenation (ECMO) in thoracic surgery, exclusive of lung transplantation. Although the use of ECMO in this indication is still rare, it allows surgery to be performed in patients where conventional ventilation is not feasible-especially in single lung patients, sleeve lobectomy or pneumonectomy and tracheal or carinal reconstructions. Comparisons with other techniques, various ECMO configurations, the management of anticoagulation, anesthesia, hypoxemia during surgery and the use of ECMO in case of postoperative respiratory failure are reviewed and supported by two cases of perioperative ECMO use, and an overview of published case series.
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Affiliation(s)
- Pavel Suk
- International Clinical Research Center, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic
- Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
- Correspondence: (P.S.); (I.Č.J.)
| | - Vladimír Šrámek
- Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Ivan Čundrle
- International Clinical Research Center, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic
- Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
- Correspondence: (P.S.); (I.Č.J.)
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Pola Dos Reis F, Minamoto H, Bibas BJ, Minamoto FEN, Cardoso PFG, Caneo LF, Pêgo-Fernandes PM. Treatment of tracheal stenosis with extracorporeal membrane oxygenation support in infants and newborns. Artif Organs 2021; 45:748-753. [PMID: 33350476 DOI: 10.1111/aor.13898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022]
Abstract
Tracheal stenosis in children is a challenge for the healthcare team, since it is a rare disease. Patients usually have other clinical comorbidities, mainly previous cardiac surgical interventions. This retrospective single-center study included infants with tracheal stenosis (congenital or acquired) operated between 2016 and 2020 on venoarterial extracorporeal membrane oxygenation (VA ECMO). Five patients were operated and the median age of detection of the tracheal disease was 3.7 months, and the median age at the operation was 5 months. All patients had associated cardiac anomalies. Four patients had congenital tracheal stenosis; two with associated pig bronchus. One patient had acquired subglottic stenosis with concomitant stenosis at the carina. After the operation, the patients were referred to ICU on ECMO with an open chest. Minor ECMO-related complications occurred in two patients (hemothorax and wound infection). All patients required endoscopic evaluation during the postoperative care; median of 3.2 procedures. Two patients are currently in follow-up and three have died. Slide tracheoplasty with VA-ECMO can be successfully performed in infants with prior cardiac surgery. Nevertheless, a difficult postoperative course should be anticipated, with possible prolonged ECMO use, readmissions, and higher morbidity and mortality than in children with tracheal stenosis alone.
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Affiliation(s)
- Flavio Pola Dos Reis
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Grupo de ECMO, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Helio Minamoto
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Benoit Jacques Bibas
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabio Eiti Nishibe Minamoto
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Luiz Fernando Caneo
- Grupo de ECMO, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Divisao de Cirurgia Pediatrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Kim DH, Park JM, Son J, Lee SK. Multivariate Analysis of Risk Factor for Mortality and Feasibility of Extracorporeal Membrane Oxygenation in High-Risk Thoracic Surgery. Ann Thorac Cardiovasc Surg 2021; 27:97-104. [PMID: 33536388 PMCID: PMC8058542 DOI: 10.5761/atcs.oa.20-00224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) as intraoperative cardiorespiratory support during lung transplantation is well known, but use for other types of surgery are limited. To assess risk factor for mortality after high-risk thoracic surgery and feasibility of ECMO, we reviewed. Methods: This study was an observational study. Between January 2011 and October 2018, 63 patients underwent thoracic surgery with ECMO for severe airway disease, pulmonary insufficiency requiring lung surgery, and other conditions. Results: In all, 46 patients remained alive at 30 days after surgery. The mean patient age was 50.38 ± 16.16 years. ECMO was most commonly used to prevent a lethal event (34 [73.9%]) in the Survival (S) group and rescue intervention (13 [76.5%]) in the Non-survival (N) group. In all, 11 patients experienced arrest during surgery (S vs N: 2 [4.3%] vs 9 [52.9%], p ≤0.001). The multivariate analysis revealed that arrest during surgery (odds ratio [OR], 24.44; 95% confidence interval [CI], 1.82–327.60; p = 0.016) and age (OR, 7.47; 95% CI, 1.17–47.85; p = 0.034) were independently associated with mortality. Conclusions: ECMO provides a safe environment during thoracic surgery, and its complication rate is acceptable except for extracorporeal cardiopulmonary resuscitation (ECPR).
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Affiliation(s)
- Do Hyung Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jong Myung Park
- Department of Thoracic and Cardiovascular Surgery, Busan Medical Center, Yeonje-Gu, Busan, Korea
| | - Joohyung Son
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Kwang Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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8
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Spaggiari L, Sedda G, Petrella F, Venturino M, Rossi F, Guarize J, Galetta D, Casiraghi M, Iacono GL, Bertolaccini L, Alamanni F. Preliminary Results of Extracorporeal Membrane Oxygenation Assisted Tracheal Sleeve Pneumonectomy for Cancer. Thorac Cardiovasc Surg 2020; 69:240-245. [PMID: 32814351 DOI: 10.1055/s-0040-1714071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Tracheal sleeve pneumonectomy is a challenge in lung cancer management and in achieving long-term oncological results. In November 2018, we started a prospective study on the role of extracorporeal membrane oxygenation (ECMO) in tracheal sleeve pneumonectomy. We aim to present our preliminary results. METHODS From November 2018 to November 2019, six patients (three men and three women; median age: 61 years) were eligible for tracheal sleeve pneumonectomy for lung cancer employing the veno-venous ECMO during tracheobronchial anastomosis. RESULTS Only in one patient, an intrapericardial pneumonectomy without ECMO support was performed, but cannulas were maintained during surgery. The median length of surgery was 201 minutes (range: 162-292 minutes), and the average duration of the apneic phase was 38 minutes (range: 31-45 minutes). No complications correlated to the positioning of the cannulas were recorded. There was only one major postoperative complication (hemothorax). At the time of follow-up, all patients were alive; one patient alive with bone metastasis was being treated with radiotherapy. CONCLUSION ECMO-assisted oncological surgery was rarely described, and its advantages include hemodynamic stability with low bleeding complications and a clean operating field. As suggested by our preliminary data, ECMO-assisted could be a useful alternative strategy in select lung cancer patients.
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Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Marco Venturino
- Department of Anesthesiology, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Fabiana Rossi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Juliana Guarize
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Domenico Galetta
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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9
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Abstract
Background: Despite the rapid integration of extracorporeal membrane oxygenation (ECMO) into intensive care units over the past decade, established programs for training critical care clinicians to provide ECMO are lacking. Objective: To evaluate the development and implementation of a multidisciplinary ECMO training program for the rapid deployment of ECMO training for a high volume of critical care clinicians. Methods: We performed a prospective cohort study examining a program for rapid training of multiple disciplines of critical care clinicians to deliver ECMO during the implementation of ECMO services across the intensive care units of an academic tertiary care center between October 2018 and January 2019. The multidisciplinary ECMO training program included didactic and simulation-based teaching and emphasized new, universal clinical protocols to improve consistency of care across the institution. Pre- and post-program written examinations evaluated knowledge acquisition, and an electronically distributed program evaluation assessed perceptions of content and delivery. Results: Among the 97 clinicians who completed the program, 49 (51%) were physicians and 48 (49%) were advanced practice providers from the departments of surgery (n = 42), medicine (n = 29), and anesthesia (n = 26). There was a significant difference in knowledge about ECMO between the pre- and post-program examination score (median [interquartile range] 70% [60–80%] vs. 90% [80–90%], respectively, P < 0.001). The median (interquartile range) individual gain from pre- to post-program score was 20% (10–30%). The program was perceived as useful and applicable to safe care. Conclusion: Rapid deployment of a multidisciplinary ECMO training program across a large academic center was feasible, achieved knowledge acquisition, and was positively perceived.
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Gannon WD, Craig L, Netzel L, Mauldin C, Troutt A, Warhoover M, Tipograf Y, Hogrefe K, Rice TW, Shah A, Bacchetta M. Curriculum to Introduce Critical Care Nurses to Extracorporeal Membrane Oxygenation. Am J Crit Care 2020; 29:262-269. [PMID: 32607573 DOI: 10.4037/ajcc2020739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Despite the growing use of extracorporeal membrane oxygenation (ECMO) in intensive care units (ICUs), no standardized ECMO training pathways are available for ECMO-naive critical care nurses. OBJECTIVES To evaluate a critical care nurse ECMO curriculum that may be reproducible across institutions. METHODS An ECMO curriculum consisting of a basic safety course and an advanced user course was designed for critical care nurses. Courses incorporated didactic and simulation components, written knowledge examinations, and electronic modules. Differences in examination scores before and after each course for the overall cohort and for participants from each ICU type were analyzed with t tests or nonparametric equality-of-medians tests. Differences in postcourse scores across ICU types were examined with multiple linear regression. RESULTS Critical care nurses new to ECMO (n = 301) from various ICU types participated in the basic safety course; 107 nurses also participated in the advanced user course. Examination scores improved after completion of both courses for overall cohorts (P < .001 in all analyses). Median (interquartile range) individual score improvements were 23.1% (15.4%-38.5%) for the basic safety course and 8.4% (0%-16.7%) for the advanced user course. Postcourse written examination scores stratified by ICU type, compared with the medical ICU/cardiovascular ICU group (reference group), differed only in the neurovascular ICU group for the basic safety course (percent score difference, -3.0; 95% CI, -5.3 to -0.8; P = .01). CONCLUSIONS Implementation of an ECMO curriculum for a high volume of critical care nurses is feasible and effective.
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Affiliation(s)
- Whitney D. Gannon
- About the Authors: Whitney D. Gannon is director of ECMO quality and training, Lindsey Netzel is nurse educator in the medical intensive care unit (MICU), and Todd W. Rice is MICU director and a pulmonary and critical care attending physician, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynne Craig
- Lynne Craig and Ashley Troutt are ECMO coordinators, Carmen Mauldin is a nurse educator in the cardiovascular ICU, Matthew Warhoover is a perfusionist, and Ashish Shah is director and chairman, Department of Cardiac Surgery, and codirector of the ECMO program, Vanderbilt University Medical Center
| | - Lindsey Netzel
- Lynne Craig and Ashley Troutt are ECMO coordinators, Carmen Mauldin is a nurse educator in the cardiovascular ICU, Matthew Warhoover is a perfusionist, and Ashish Shah is director and chairman, Department of Cardiac Surgery, and codirector of the ECMO program, Vanderbilt University Medical Center
| | - Carmen Mauldin
- Lynne Craig and Ashley Troutt are ECMO coordinators, Carmen Mauldin is a nurse educator in the cardiovascular ICU, Matthew Warhoover is a perfusionist, and Ashish Shah is director and chairman, Department of Cardiac Surgery, and codirector of the ECMO program, Vanderbilt University Medical Center
| | - Ashley Troutt
- Lynne Craig and Ashley Troutt are ECMO coordinators, Carmen Mauldin is a nurse educator in the cardiovascular ICU, Matthew Warhoover is a perfusionist, and Ashish Shah is director and chairman, Department of Cardiac Surgery, and codirector of the ECMO program, Vanderbilt University Medical Center
| | - Matthew Warhoover
- Lynne Craig and Ashley Troutt are ECMO coordinators, Carmen Mauldin is a nurse educator in the cardiovascular ICU, Matthew Warhoover is a perfusionist, and Ashish Shah is director and chairman, Department of Cardiac Surgery, and codirector of the ECMO program, Vanderbilt University Medical Center
| | - Yuliya Tipograf
- Yuliya Tipograf is a surgery resident at Vanderbilt University Medical Center and Columbia University Medical Center, New York, New York
| | - Katherine Hogrefe
- Katherine Hogrefe is an associate program manager, Department of Nursing Education and Professional Development, Vanderbilt University Medical Center
| | - Todd W. Rice
- About the Authors: Whitney D. Gannon is director of ECMO quality and training, Lindsey Netzel is nurse educator in the medical intensive care unit (MICU), and Todd W. Rice is MICU director and a pulmonary and critical care attending physician, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashish Shah
- Lynne Craig and Ashley Troutt are ECMO coordinators, Carmen Mauldin is a nurse educator in the cardiovascular ICU, Matthew Warhoover is a perfusionist, and Ashish Shah is director and chairman, Department of Cardiac Surgery, and codirector of the ECMO program, Vanderbilt University Medical Center
| | - Matthew Bacchetta
- Matthew Bacchetta is an attending physician in the Department of Thoracic Surgery and co-director of the ECMO program at Vanderbilt University Medical Center
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11
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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.
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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
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12
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Reis FPD, Costa AN, Lauricella LL, Terra RM, Pêgo-Fernandes PM. Intraoperative support with venovenous extracorporeal membrane oxygenation for complex thoracic oncologic resection. ACTA ACUST UNITED AC 2020; 46:e20180416. [PMID: 31967273 PMCID: PMC7462687 DOI: 10.1590/1806-3713/e20180416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Flávio Pola Dos Reis
- . Divisão de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Andre Nathan Costa
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Leticia Leone Lauricella
- . Divisão de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Ricardo Mingarini Terra
- . Divisão de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Paulo Manoel Pêgo-Fernandes
- . Divisão de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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13
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The Role of Extracorporeal Life Support in Thoracic Surgery. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Carinal surgery: A single-institution experience spanning 2 decades. J Thorac Cardiovasc Surg 2019; 157:2073-2083.e1. [DOI: 10.1016/j.jtcvs.2018.11.130] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 11/22/2022]
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15
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McVey MJ, Kuebler WM. Extracellular vesicles: biomarkers and regulators of vascular function during extracorporeal circulation. Oncotarget 2018; 9:37229-37251. [PMID: 30647856 PMCID: PMC6324688 DOI: 10.18632/oncotarget.26433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022] Open
Abstract
Extracellular vesicles (EVs) are generated at increased rates from parenchymal and circulating blood cells during exposure of the circulation to abnormal flow conditions and foreign materials associated with extracorporeal circuits (ExCors). This review describes types of EVs produced in different ExCors and extracorporeal life support (ECLS) systems including cardiopulmonary bypass circuits, extracorporeal membrane oxygenation (ECMO), extracorporeal carbon dioxide removal (ECCO2R), apheresis, dialysis and ventricular assist devices. Roles of EVs not only as biomarkers of adverse events during ExCor/ECLS use, but also as mediators of vascular dysfunction are explored. Manipulation of the number or subtypes of circulating EVs may prove a means of improving vascular function for individuals requiring ExCor/ECLS support. Strategies for therapeutic manipulation of EVs during ExCor/ECLS use are discussed such as accelerating their clearance, preventing their genesis or pharmacologic options to reduce or select which and how many EVs circulate. Strategies to reduce or select for specific types of EVs may prove beneficial in preventing or treating other EV-related diseases such as cancer.
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Affiliation(s)
- Mark J McVey
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, SickKids, Toronto, ON, Canada
| | - Wolfgang M Kuebler
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Heart Institute, Berlin, Germany
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16
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Monaco F, Belletti A, Bove T, Landoni G, Zangrillo A. Extracorporeal Membrane Oxygenation: Beyond Cardiac Surgery and Intensive Care Unit: Unconventional Uses and Future Perspectives. J Cardiothorac Vasc Anesth 2018; 32:1955-1970. [DOI: 10.1053/j.jvca.2018.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Indexed: 02/06/2023]
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17
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Affiliation(s)
- Hovig V Chitilian
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Xiadong Bao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Paul H Alfille
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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18
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Short veno-venous extracorporeal membrane oxygenation assisted segmentectomy for second primary lung tumor in a patient with insufficient respiratory function for one lung ventilation. Respir Med Case Rep 2018; 24:176-178. [PMID: 29977790 PMCID: PMC6010642 DOI: 10.1016/j.rmcr.2018.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 05/26/2018] [Accepted: 05/26/2018] [Indexed: 11/25/2022] Open
Abstract
Advances in extracorporeal membrane oxygenation (ECMO) have allowed safe performance of complex thoracic surgical procedures that were impossible before. Application of ECMO in general thoracic surgery is extremely rare, but allows life-saving procedures in patients in whom one-lung ventilation cannot be carried out safely. We present the case of a 66 year old man who underwent a challenging veno-venous ECMO assisted segmentectomy for a second primary lung cancer. One-lung ventilation was not feasible due to previous lobectomy on the contralateral side and consequent lack of respiratory function. After the surgical procedure was completed the ECMO was removed and under stable conditions followed the immediate tracheal extubation.
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19
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Kuckelman J, Cuadrado DG. Care of the Postoperative Pulmonary Resection Patient. SURGICAL CRITICAL CARE THERAPY 2018. [PMCID: PMC7120963 DOI: 10.1007/978-3-319-71712-8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patients undergoing pulmonary resection all exhibit, to some degree, a level of pulmonary dysfunction. This is due to the physiologic stress of the procedure performed, the patient’s comorbidities, and preexisting cardiopulmonary reserve. Although prognostic factors for intensive care requirement exist, to date, there is no consensus for postoperative admission. Institutional practices vary across the country, with patients often admitted to intensive care for surveillance. Guidelines published from the American Thoracic Society in 1999 emphasize that admission to the ICU be reserved for those patients requiring care and monitoring for severe physiologic instability. Admissions following pulmonary resection are typically due to respiratory complications and are an independent predictor of mortality. The following chapter will review the indications for admission to the ICU and common issues encountered following pulmonary resection and conclude with a discussion of the management of patients undergoing pulmonary transplantation.
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20
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Bazarov DV, Belov YV, Charchyan ER, Lokshin LS, Akselrod BA, Eremenko AA, Grigorchuk AY, Volkov AA. [Cardiopulmonary bypass in thoracic surgery]. Khirurgiia (Mosk) 2017:31-43. [PMID: 29076480 DOI: 10.17116/hirurgia20171031-43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To analyze advisability of cardiopulmonary bypass in thoracic surgery. MATERIAL AND METHODS We estimated early and long-term results of CPB-assisted thoracic interventions in 31 patients with malignant and benign thoracic diseases and invasion into vital mediastinal structures or with concomitant cardiovascular pathology. RESULTS Acceptable rates of mortality and morbidity confirm safety of CPB in thoracic surgery while satisfactory long-term outcomes are arguments in favor of this direction of thoracic oncology.
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Affiliation(s)
- D V Bazarov
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - Yu V Belov
- Petrovsky Russian Research Center of Surgery, Moscow, Russia; Chair of Hospital Surgery of Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - E R Charchyan
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - L S Lokshin
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - B A Akselrod
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A A Eremenko
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A Yu Grigorchuk
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A A Volkov
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
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21
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The Utility of High-Fidelity Simulation for Training Critical Care Fellows in the Management of Extracorporeal Membrane Oxygenation Emergencies: A Randomized Controlled Trial. Crit Care Med 2017; 45:1367-1373. [PMID: 28422779 DOI: 10.1097/ccm.0000000000002437] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Although extracorporeal membrane oxygenation volume has increased, proficiency in the technology requires extensive training. We compared traditional water-drill-based extracorporeal membrane oxygenation training with simulation-based extracorporeal membrane oxygenation training with the hypothesis that simulation-based training is superior. DESIGN Randomized controlled trial. SETTING Academic medical center. SUBJECTS Pulmonary/critical care fellows. INTERVENTIONS Participants had a preintervention simulated extracorporeal membrane oxygenation emergency (Sim1-recirculation) then randomized into simulation and traditional groups. Each group participated in three teaching scenarios, via high-fidelity simulation or via water-drills. After 6 weeks and after 1 year, participants returned for two simulated extracorporeal membrane oxygenation emergencies (Sim2-pump failure and Sim3-access insufficiency). Sim2 was a case encountered during teaching, whereas Sim3 was novel. A critical action, necessary for resolution of each scenario, was preidentified for timing. MEASUREMENTS AND MAIN RESULTS Primary outcome was time required to perform critical actions. Twenty-one fellows participated in the study (simulation, 10; traditional, 11). Groups had similar scenario scores (p = 0.4) and times to critical action (p = 0.8) on Sim1. At 6 weeks, both groups had similar scenario scores on Sim2 (p = 0.5), but the simulation group scored higher on Sim3 (p = 0.03). Times to critical actions were shorter in the simulation group during Sim2 (127 vs 174 s, p = 0.004) and Sim3 (159 vs 300 s; p = 0.04). These findings persisted at 1 year. CONCLUSIONS In novice critical care fellows, simulation-based extracorporeal membrane oxygenation training is superior to traditional training. Benefits transfer to novel scenarios and are maintained over the long term. Further studies evaluating the utility of simulation in other learner groups and for maintenance of proficiency are required.
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22
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Ahuja S, Cohen B, Hinkelbein J, Diemunsch P, Ruetzler K. Practical anesthetic considerations in patients undergoing tracheobronchial surgeries: a clinical review of current literature. J Thorac Dis 2016; 8:3431-3441. [PMID: 28066624 DOI: 10.21037/jtd.2016.11.57] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tracheobronchial surgeries require close cooperation and extensive communication between the anesthesia providers and the surgeons. Anesthetic management of tracheal and bronchial pathologies differ basically from regular upper airways management, due access to the patients airway is limited, mostly even practically impossible for the anesthesia providers. As a consequence, the surgeon overtakes responsibility for the airway access from the anesthesia provider in the variety of the cases. Preoperative recognition of a difficult airway, detailed planning and being aware of plan B and plan C are the elementary keys to success. Providers have to be aware, that preoperative airway assessment does not always correlate with the ease of oxygenation and ventilation. Therefore, various methods have been described in the literature and several authors have adopted unique ways to manage the airways in a successful manner. With the advancement of surgical techniques over the years, anesthetic management has also evolved tremendously to match the needs. The commonly encountered conditions requiring surgical interventions include post-intubation stenosis and foreign body aspiration. In this review we will discuss the most common pathologies of tracheobronchial lesions and specific anesthetic management considerations related to them.
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Affiliation(s)
- Sanchit Ahuja
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Barak Cohen
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jochen Hinkelbein
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany
| | - Pierre Diemunsch
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals of Hautepierre, Strasburg, France
| | - Kurt Ruetzler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA;; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
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