Hypoxia During One-Lung Ventilation-A Review and Update.

The use of extracorporeal membrane oxygenation (ECMO) for elective thoracic surgical procedures has been infrequently reported in the anaesthetic literature. We report the use of intraoperative veno-venous ECMO support for a patient with a previous left pneumonectomy who required a right-sided thoracotomy for repair of a tracheo-oesophageal fistula. To avoid traumatising or pressurising the fistula, a spontaneous ventilation technique was used prior to intubation with a single-lumen endotracheal tube positioned above the level of the fistula. The ECMO cannulas were inserted after induction and ECMO was instituted prior to transfer to the lateral position. Oxygenation during ECMO was augmented with apnoeic oxygen delivery via the breathing circuit. This was associated with an increase in the oxygen saturations from 80% to 99% without compromising surgical access. The use of apnoeic oxygenation via the breathing circuit significantly improved gas exchange in this case and should be considered as an adjunct to veno-venous ECMO.

Veno-venous extracorporeal membrane oxygenation and apnoeic oxygenation for tracheo-oesophageal fistula repair in a previously pneumonectomised patient.

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 5038 ± 1616 years ECMO was most commonly used to prevent a lethal event (34 [739%]) in the Survival (S) group and rescue intervention (13 [765%]) in the Non-survival (N) group In all, 11 patients experienced arrest during surgery (S vs N: 2 [43%] vs 9 [529%], p ≤0001) The multivariate analysis revealed that arrest during surgery (odds ratio [OR], 2444; 95% confidence interval [CI], 182-32760; p = 0016) and age (OR, 747; 95% CI, 117-4785; p = 0034) 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)

https://www.jstage.jst.go.jp/article/atcs/27/2/27_oa.20-00224/_pdf

Multivariate Analysis of Risk Factor for Mortality and Feasibility of Extracorporeal Membrane Oxygenation in High-Risk Thoracic Surgery

Application of Extracorporeal Membrane Oxygenation in Giant Bullae Resection

Auch in der Thoraxchirurgie sind in den letzten Jahren Behandlungspfade im Rahmen von „Enhanced-Recovery-after-Surgery“-Programmen entwickelt worden. Neben minimalinvasiven Operationstechniken sind dabei eine Vielzahl von anasthesiologischen Aspekten wie die Wahl kurz wirksamer Narkoseregime, der Einsatz von Regionalanalgesie, eine ausgeglichene intraoperative Flussigkeitstherapie, die Vermeidung von postoperativer Ubelkeit und Erbrechen und vor allem eine protektive Beatmung zu berucksichtigen. Bei einem Patientenkollektiv, das zunehmend auch bei vorbestehenden, teils schweren Lungenfunktionsstorungen operiert werden muss, fuhrt eine protektive Beatmung unter den Bedingungen einer Ein-Lungen-Ventilation haufig zu schweren Gasaustauschstorungen. In dieser Situation stellt der Einsatz einer venovenosen extrakorporalen Membranoxygenierung (vvECMO) eine suffiziente und sichere Methode dar, die perioperative Behandlung dieser Patienten zu ermoglichen. Auch postoperativ kann die Genesung der Patienten durch eine Weiterfuhrung des Verfahrens im Wachzustand sowohl notwendige Masnahmen, wie Physio- und Atemtherapie und die Fruhmobilisation, als auch die Ausheilung von Luftfistelung der operierten Lunge begunstigen. Zur Vermeidung von Blutungskomplikationen kann die ECMO aufgrund der Heparinbeschichtung der Schlauchsysteme intraoperativ zunachst ohne Antikoagulation betrieben werden. Postoperative Optionen der Antikoagulation stellen Heparin, Argatroban oder Bivalirudin dar. Auch neue Techniken, wie die minimalinvasive Thoraxchirurgie unter Regionalanasthesie mit Sedierung, konnen in der Zukunft moglicherweise durch den Einsatz einer vvECMO weiterentwickelt werden.

Extrakorporale Membranoxygenierung in der Thoraxchirurgie: die Sicht des Anästhesisten

Background Esophagectomy after pneumonectomy has been rarely reported, mainly due to the technical difficulty in performing this surgical approach. Conventional intubation to the contralateral respiratory passage is technically challenging, while the homolateral respiratory tract is absent, making oxygenation impossible. Methods To overcome this problem, we used venoarterial (VA) extracorporeal membrane oxygenation (ECMO) which can help achieve gas exchange despite the collapsed lung and provide a clear unobstructed surgical field for esophagectomy. Results We obtained satisfactory outcomes with VA ECMO in our treated patient. Conclusions This technique may be an excellent option for the treatment of complex situations such as esophagectomy after pneumonectomy.

ECMO-assisted esophagectomy after left pneumonectomy.

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ECMO-assisted esophagectomy after left pneumonectomy.