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Thorac Cardiovasc Surg 2021; 69(03): 231-239
DOI: 10.1055/s-0040-1708486
Original Thoracic

Use of Extracorporeal Membrane Oxygenation for Major Cardiopulmonary Resections

Aris Koryllos
1   Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
,
Alberto Lopez-Pastorini
1   Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
,
Thomas Galetin
1   Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
,
Jerome Defosse
2   Department of Anaesthesiology and Intensive Care Medicine, Kliniken der Stadt Köln gGmbH, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
,
Stephan Strassmann
3   ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
,
Christian Karagiannidis
3   ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
,
Erich Stoelben
1   Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
› Author Affiliations Funding None.
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Abstract

Background In thoracic surgery, utilization of extracorporeal membrane oxygenation (ECMO) is mainly established for patients undergoing lung transplantation. The aim of our study was to summarize our single-center experience with intraoperative use of veno-venous- or veno-arterial-ECMO in patients undergoing complex lung surgery involving the main carina, or the left atrium or the descending aorta.

Methods A total of 24 patients underwent combined complex lung, carinal, aortal, or left atrial resections. In cases of carinal resection, percutaneous veno-venous, jugular–femoral cannulation was considered suitable. For combined resection of lung and descending aorta, a percutaneous femoral veno-arterial cannulation was used. In cases of extended left atrial resection, a percutaneous jugular–femoral veno-venous-arterial cannulation was favored.

Results Procedures were divided into three groups: carinal resections and reconstruction (n = 8), resections of the descending aorta and left lung (n = 7), resections of lung and left atrium (n = 9). No intraoperative complications occurred. Overall 30-day mortality was 25%. A complete resection was achieved in 18 patients. Median survival was 12 months. One- and 5-year survival were 48.1 and 22.7%, respectively.

Conclusion The present study shows that intraoperative use of ECMO for extended carinal, aortic, or atrial resections is feasible with minimal intraoperative complications allowing surgeons increased operating-field safety. Perioperative mortality is high, but this is rather an attribute of local extended disease and patient comorbidities.

Keywords

extracorporeal membrane oxygenation - ECMO - aorta/aortic - airway


Publication History

Received: 24 November 2019

Accepted: 27 January 2020

Article published online:
08 April 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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