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Lopez-Pastorini A, Stoelben E. [Carinal Resections]. Zentralbl Chir 2024; 149:298-307. [PMID: 38359867 DOI: 10.1055/a-2240-9974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Carinal resections are consistently described in the literature as one of the most challenging procedures in thoracic surgery. Depending on the underlying disease and its extent, different resection forms and reconstruction techniques are required. From a surgical point of view, the complex anatomy, and the technique of reconstruction of the central airway are particularly challenging. However, complex airway management and extensive postoperative follow-up demonstrate that these procedures require a multidisciplinary team effort beyond surgical expertise. This article reviews the most important pre-, intra-, and post-operative aspects of these challenging procedures.
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Affiliation(s)
| | - Erich Stoelben
- Thoraxklinik Köln, St. Hildegardis-Krankenhaus, Köln, Deutschland
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Zwaenepoel B, Vandewiele K, Peperstraete H, De Ryck F, Vanpeteghem C, Malfait T, Herck I, Vandenberghe W, Van Laethem L, Defreyne L, Van Braeckel E, Depuydt P, Schaubroeck H. Video-assisted thoracic surgery in critically ill COVID-19 patients on venovenous extracorporeal membrane oxygenation. Perfusion 2023; 38:1577-1583. [PMID: 35969115 PMCID: PMC9379594 DOI: 10.1177/02676591221119319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) leads to thoracic complications requiring surgery. This is challenging, particularly in patients supported with venovenous extracorporeal membrane oxygenation (VV-ECMO) due to the need for continuous therapeutic anticoagulation. We aim to share our experience regarding the safety and perioperative management of video-assisted thoracic surgery for this specific population. METHODS Retrospective, single-center study between November 2020 and January 2022 at the ICU department of a 1.061-bed tertiary care and VV-ECMO referral center during the COVID-19 pandemic. RESULTS 48 COVID-19 patients were supported with VV-ECMO. A total of 14 video-assisted thoracic surgery (VATS) procedures were performed in seven patients. Indications were mostly hemothorax (85.7%). In eight procedures heparin was stopped at least 1 h before incision. A total of 10 circuit changes due to clot formation or oxygen transfer failure were required in six patients (85.7%). One circuit replacement seemed related to the preceding VATS procedure, although polytransfusion might be a contributing factor. None of the mechanical complications was fatal. Four VATS-patients (57.1%) died, of which two (50%) immediately perioperatively due to uncontrollable bleeding. All three survivors were treated with additional transarterial embolization. CONCLUSION (1) Thoracic complications in COVID-19 patients on VV-ECMO are common. (2) Indication for VATS is mostly hemothorax (3) Perioperative mortality is high, mostly due to uncontrollable bleeding. (4) Preoperative withdrawal of anticoagulation is not directly related to a higher rate of ECMO circuit-related complications, but a prolonged duration of VV-ECMO support and polytransfusion might be. (5) Additional transarterial embolization to control postoperative bleeding may further improve outcomes.
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Affiliation(s)
- Bert Zwaenepoel
- Department of Cardiology, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Korneel Vandewiele
- Department of Perfusion, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Harlinde Peperstraete
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frederic De Ryck
- Department of Thoracic and Vascular
Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Caroline Vanpeteghem
- Department of Anesthesiology, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Thomas Malfait
- Department of Respiratory Medicine,
Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ingrid Herck
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Wim Vandenberghe
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Lien Van Laethem
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Luc Defreyne
- Department of Interventional
Radiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Eva Van Braeckel
- Department of Respiratory Medicine,
Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Internal Medicine and
Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Pieter Depuydt
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Internal Medicine and
Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannah Schaubroeck
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
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Santos Silva J, Cabral D, Calvinho PA, Olland A, Falcoz PE. Extracorporeal life support use in limited lung function: a narrative review. J Thorac Dis 2023; 15:5239-5247. [PMID: 37868846 PMCID: PMC10586950 DOI: 10.21037/jtd-22-1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 07/14/2023] [Indexed: 10/24/2023]
Abstract
Background and Objective In thoracic surgery, different modalities of extracorporeal life support (ECLS) can be used for cardiorespiratory support in complex scenarios. Decades of learning in clinical practice and physiology associated with technological development led to a great variety of ECLS technologies available. Thoracic surgery procedures with difficult or impossible single lung ventilation may still be performed using different ECLS modalities. The aim of this review is to describe the use of ECLS, with its different modalities, as a solution to perform complex surgeries in a patient with difficult or impossible single lung ventilation. Methods A literature review was conducted using the terms "extracorporeal life support pulmonary resection" and "extracorporeal life support thoracic surgery", and articles were selected according to defined criteria. Key Content and Findings To support lung function during thoracic surgery, the most efficient and popular variety of ECLS is venovenous extracorporeal membrane oxygenation. Lung resection on a single lung after pneumonectomy, surgery in a patient with severe hypercapnia and/or low respiratory reserve, carinal and airway surgery, and severe thoracic trauma are the main examples of situations where ECLS may be the solution to provide a safe surgical environment in patients who cannot tolerate single lung ventilation. Multidisciplinarity, selection of patients and careful surgical planning are cornerstones in defining the situations that may benefit from ECLS support. Conclusions Knowledge on techniques of ECLS are essential for every thoracic surgeon. Although rarely used, these techniques of cardiorespiratory support should be considered when planning complex cases with difficulties in ventilation and emergent situations.
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Affiliation(s)
- João Santos Silva
- Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Daniel Cabral
- Serviço de Cirurgia Torácica, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Paulo Almeida Calvinho
- Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Anne Olland
- Hôpitaux Universitaire de Strasbourg, Service de chirurgie thoracique-Nouvel Hôpital Civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
- Université de Strasbourg, Faculté de médecine et pharmacie, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Hôpitaux Universitaire de Strasbourg, Service de chirurgie thoracique-Nouvel Hôpital Civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
- Université de Strasbourg, Faculté de médecine et pharmacie, Strasbourg, France
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Marziali V, Mangiameli G, Crepaldi A, Piccioni F, Costantini E, Citterio E, Borbone A, Cariboni U. Right tracheal sleeve pneumonectomy with VV-ECMO assistance for non-small cell lung cancer through anterior thoracotomy: a single centre experience. Front Surg 2023; 10:1238462. [PMID: 37601529 PMCID: PMC10435269 DOI: 10.3389/fsurg.2023.1238462] [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: 06/11/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
For a long time, non-small cell lung cancer (NSCLC) arising less than 2 cm distal to the carina has been usually considered unresectable and incurable with a radical or extended resection because of surgical technical difficulty and airway management. Recently, the introduction of more advanced surgical techniques, often including the use of extracorporeal life support (ECLS), has allowed us to extend the limits of conventional surgery, increasing the rate of complete surgical resection. ECLS also overcomes the limitation of conventional ventilation during complex tracheo-bronchial reconstruction, avoiding the presence of disturbing lines or tubes that obstruct the operative field during a challenging surgery. In this article, we share our experience in performing right tracheal sleeve pneumonectomy with veno-venous extracorporeal membrane oxygenation (VV-ECMO) in three cases by anterior right thoracotomy, reporting our tips and tricks.
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Affiliation(s)
- Valentina Marziali
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Crepaldi
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Federico Piccioni
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Costantini
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Enrico Citterio
- Department of Cardiac Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alessandro Borbone
- Department of Cardiac Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
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Kimura T, Kobayashi T, Kobori F, Goto M, Takemitsu M, Tanaka A, Sato J, Isomine S. Massive hemoptysis managed by prolonged anticoagulation-free veno-venous extracorporeal membrane oxygenation with which thoracic surgeries were accompanied: a case report. JA Clin Rep 2022; 8:11. [PMID: 35190925 PMCID: PMC8861252 DOI: 10.1186/s40981-022-00503-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 12/29/2022] Open
Abstract
Background Massive hemoptysis causing inadequate ventilation results in life-threatening consequences. We present a patient who developed respiratory insufficiency produced by bronchiectatic massive hemoptysis and underwent prolonged anticoagulation-free veno-venous extracorporeal membrane oxygenation (VV-ECMO) during which thoracic surgeries were performed. Case presentation A 79-year-old woman suffered massive hemoptysis resulting in respiratory failure during fiberoptic bronchoscopy. Bronchial intubation followed by one lung ventilation failed to ensure adequate oxygenation. Anticoagulation-free VV-ECMO, therefore, was installed immediately. Since conservative hemostatic measures including bronchial arterial embolization were not effective, resection of the culprit lung was performed while on VV-ECMO. Next day an exploratory thoracotomy and intercostal artery embolization were needed for recurrent bleeding. The VV-ECMO was withdrawn after five days of operation. Conclusions Massive hemoptysis can be fatal and needs instantaneous and intensive treatments. In our case, long-term anticoagulation-free VV-ECMO during which thoracic surgeries and endovascular interventions were performed provided a favorable outcome.
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Challenges in the Extracorporeal Membrane Oxygenation Era. MEMBRANES 2021; 11:membranes11110829. [PMID: 34832058 PMCID: PMC8620737 DOI: 10.3390/membranes11110829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022]
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