Intraoperative veno-venous extracorporeal membrane oxygenation (V-V ECMO) lung support in thoracic surgery – initial single center experience

Background:

Intraoperative extracorporeal lung support (ECLS) was developed as a mechanical support device to improve gas exchange (oxygenation and CO₂ removal) or facilitate the blood circulation. Using cardiopulmonary bypass (CPB) in thoracic surgery is limited for need of full heparinisation and therefore high risk of postoperative bleeding. On the other hand veno-venous extracorporeal membrane oxygenation (V-V ECMO, can be safely used with no, or minimal anticoagulation in perioperative period. Patients with limited pulmonary function or after pneumonectomy are unsuitable for one lung ventilation. This has led to use intraoperative V-V ECMO (or exceptionally veno-arterial (VA) ECMO) to feasible thoracic surgery procedures in limited number of suitable candidates. Curently, aplication of ECMO in thoracic surgery practice is described only sporadically. Herein, we would like to present our initial experience with V-V ECMO assisted thoracic surgery.

Material and method:

Two veno-venous V-V ECMO-assisted lung resections were performed from August 2017 to April 2019. Both patients were percutaneously cannulated through femoral and jugular vein. Only 3000 units of heparin were administered during cannulation; no additional anticoagulation was used during surgery.

Result:

Indication for using (V-V) ECMO was the impaired lung function after previous lung resection (lobectomy, pneumonectomy) with diagnosis of second primary lung cancer (n = 1) and reccurent pulmonary metastastatic disease (n = 1). One right upper lobectomy and one pulmonary re-metastasectomy were performed using V-V ECMO, without perioperative complications. Both patients were weaned from VV ECMO within 8 hours after surgery and from the ventilator in 20 hours.

Conclusion:

ECMO provide a sufficient complete or partial lung support during the operation avoiding bleeding complications. Careful patient selection, interdisciplinary collaboration and effective anticoagulation are important to achieve success in implementation this method in thoracic surgery practice.