Cardiopulmonary bypass as an adjunct for the noncardiac surgeon

Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report

Surgical resection of obstructive tracheal tumors can be challenging to cardiothoracic surgeons and anesthesiologists. It is often difficult in these cases to maintain oxygenation by face mask ventilation during induction of general anesthesia. Also, the extent and location of these tracheal tumors can preclude conventional induction of general anesthesia and subsequent successful endotracheal intubation. Peripheral cardiopulmonary bypass (CPB) under local anesthesia and mild intravenous sedation may be safe to support the patient until securing a definitive airway. We describe a case of a 19-year-old female with a tracheal schwannoma, who developed differential hypoxemia (Harlequin, or North-South, syndrome) after institution of awake peripheral femorofemoral venoarterial (VA) partial CBP.

[Cardiopulmonary bypass in thoracic surgery]

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.

Treatment of bronchial foreign body aspiration with extracorporeal life support in a child: A case report and literature review

We present a case in which extracorporeal life support treatment of a 6-year-old girl asphyxiated by aspiration of an elliptic plastic ball is described. The attempts for extraction of the foreign body by conventional bronchoscopy under critically ill conditions had failed. Thus, a skin incision was made in the midline, and an emergency open-chest cardiopulmonary bypass (CPB) with aortic, superior vena cava and inferior vena cava cannulation was performed for circulatory support. Following tracheal extubation, a video-assisted rigid bronchoscope was inserted to clear the airway and remove the foreign body. The CPB lasted for 68 min, and the endotracheal tube was pulled out 6 h after the surgery. On the 10th day, the patient was discharged and followed up for 3 months when no neurological symptoms or other complications were documented. The removal of the aspirated bronchial foreign body under extracorporeal life support has been rarely reported. Here, we review the indication, cannulation method, support mode, surgical procedure, and patient outcome in the 8 papers retrieved from the PubMed database and compare their clinical characteristics with those of our case to justify the safe and effective use of CPB for critically ill patients with bronchial foreign body aspiration.

Use of extracorporeal membrane oxygenation in tracheal surgery: a case series

OBJECTIVES

To review our experience of extracorporeal membrane oxygenation in airway management during tracheal surgery.

METHODS

A retrospective, observational study was conducted to evaluate the effectiveness of extracorporeal membrane oxygenation in tracheal surgery in Shanghai Chest Hospital between 2008 and 2012.

RESULTS

In all 91 tracheal surgeries, 7 high-risk cases used extracorporeal membrane oxygenation. The duration of extracorporeal membrane oxygenation support ranged from 10 min to 31 min. All extracorporeal membrane oxygenation patients underwent surgical procedures safely and there was no hospital mortality.

CONCLUSIONS

Although various advanced anesthesia techniques can ensure a safe airway in tracheal surgery in most cases, extracorporeal circulation plays an important role in high-risk cases.