Skip to main content
Erschienen in: Current Anesthesiology Reports 4/2019

16.11.2019 | Thoracic Anesthesia (T Schilling, Section Editor)

The Role of Extracorporeal Life Support in Thoracic Surgery

verfasst von: Torsten Loop, Johannes Kalbhenn, Axel Semmelmann

Erschienen in: Current Anesthesiology Reports | Ausgabe 4/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Extracorporeal life support (ECLS) is a widely used potential treatment option in patients with severe respiratory or cardiac failure with increasing significance. Routine perioperative application of ECLS is applied in cardiac and rare in thoracic surgery. This review will address the extracorporeal membrane oxygenation (ECMO) technology and basic concepts, the indications in thoracic surgery, and the intraoperative management of ECMO during surgery. The most common challenges and complications, the postoperative concept, and additional forms of support will be discussed.

Recent Findings

Technological advances in ECMO components may allow complex thoracic surgical procedures in patients in whom one-lung ventilation cannot be carried out safely without risk of hypoxia or right ventricular failure.

Summary

The indications of ECLS in thoracic surgery besides lung transplantation are mainly airway resection and reconstructive surgery in patients with obstructive tracheobronchial airway diseases. Rare indications are lung surgery in patients with poor pulmonary reserve and difficulty or impossibility of one-lung ventilation. The intraoperative management of ECMO during thoracic surgery needs professional expertise.
Literatur
1.
Zurück zum Zitat • Karagiannidis C, Brodie D, Strassmann S, Stoelben E, Philipp A, Bein T, et al. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016;42(5):889–96. https://doi.org/10.1007/s00134-016-4273-z. This retrospective study demonstrated the recent increase in ECMO utilization, which is associated with a reduction in the in-hospital mortality. Importantly, the overall mortality in ECMO patients, particularly in patients with short-term ECMO use and older patients, still remains high, which is in contrast to findings of prospective studies performed by highly experienced research groups. • Karagiannidis C, Brodie D, Strassmann S, Stoelben E, Philipp A, Bein T, et al. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016;42(5):889–96. https://​doi.​org/​10.​1007/​s00134-016-4273-z. This retrospective study demonstrated the recent increase in ECMO utilization, which is associated with a reduction in the in-hospital mortality. Importantly, the overall mortality in ECMO patients, particularly in patients with short-term ECMO use and older patients, still remains high, which is in contrast to findings of prospective studies performed by highly experienced research groups.
4.
Zurück zum Zitat • Rosskopfova P, Perentes JY, Ris HB, Gronchi F, Krueger T, Gonzalez M. Extracorporeal support for pulmonary resection: current indications and results. World J Surg Oncol. 2016;14:25. https://doi.org/10.1186/s12957-016-0781-0. This review reported the current experience of the different extracorporeal device available for the thoracic surgeon and clarify the different indications. • Rosskopfova P, Perentes JY, Ris HB, Gronchi F, Krueger T, Gonzalez M. Extracorporeal support for pulmonary resection: current indications and results. World J Surg Oncol. 2016;14:25. https://​doi.​org/​10.​1186/​s12957-016-0781-0. This review reported the current experience of the different extracorporeal device available for the thoracic surgeon and clarify the different indications.
5.
Zurück zum Zitat •• Conrad SA, Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, et al. The extracorporeal life support organization maastricht treaty for nomenclature in extracorporeal life support. A position paper of the extracorporeal life support organization. Am J Respir Crit Care Med. 2018;198(4):447–51. https://doi.org/10.1164/rccm.201710-2130CP. Classification system for ECLS nomenclature which provides a standardized foundation for the description of ECLS application, decreasing ambiguity and providing consistency for the comparison of clinical reports. •• Conrad SA, Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, et al. The extracorporeal life support organization maastricht treaty for nomenclature in extracorporeal life support. A position paper of the extracorporeal life support organization. Am J Respir Crit Care Med. 2018;198(4):447–51. https://​doi.​org/​10.​1164/​rccm.​201710-2130CP. Classification system for ECLS nomenclature which provides a standardized foundation for the description of ECLS application, decreasing ambiguity and providing consistency for the comparison of clinical reports.
11.
Zurück zum Zitat Moser B, Jaksch P, Taghavi S, Murakozy G, Lang G, Hager H, et al. Lung transplantation for idiopathic pulmonary arterial hypertension on intraoperative and postoperatively prolonged extracorporeal membrane oxygenation provides optimally controlled reperfusion and excellent outcome. Eur J Cardiothorac Surg. 2018;53(1):178–85. https://doi.org/10.1093/ejcts/ezx212.CrossRefPubMed Moser B, Jaksch P, Taghavi S, Murakozy G, Lang G, Hager H, et al. Lung transplantation for idiopathic pulmonary arterial hypertension on intraoperative and postoperatively prolonged extracorporeal membrane oxygenation provides optimally controlled reperfusion and excellent outcome. Eur J Cardiothorac Surg. 2018;53(1):178–85. https://​doi.​org/​10.​1093/​ejcts/​ezx212.CrossRefPubMed
12.
Zurück zum Zitat Rupprecht L, Lunz D, Philipp A, Lubnow M, Schmid C. Pitfalls in percutaneous ECMO cannulation. Heart Lung Vessel. 2015;7(4):320–6.PubMedPubMedCentral Rupprecht L, Lunz D, Philipp A, Lubnow M, Schmid C. Pitfalls in percutaneous ECMO cannulation. Heart Lung Vessel. 2015;7(4):320–6.PubMedPubMedCentral
18.
Zurück zum Zitat • Hoetzenecker K, Klepetko W, Keshavjee S, Cypel M. Extracorporeal support in airway surgery. J Thorac Dis. 2017;9(7):2108–17. doi:https://doi.org/10.21037/jtd.2017.06.17. This review described the published experience of ECLS in airway surgery both in adults and in pediatric patients. It highlights currently available devices and their indications. • Hoetzenecker K, Klepetko W, Keshavjee S, Cypel M. Extracorporeal support in airway surgery. J Thorac Dis. 2017;9(7):2108–17. doi:https://​doi.​org/​10.​21037/​jtd.​2017.​06.​17. This review described the published experience of ECLS in airway surgery both in adults and in pediatric patients. It highlights currently available devices and their indications.
20.
Zurück zum Zitat Johnson AP, Cavarocchi NC, Hirose H. Ventilator strategies for VV ECMO management with concomitant tracheal injury and H1N1 influenza. Heart Lung Vessel. 2015;7(1):74–80.PubMedPubMedCentral Johnson AP, Cavarocchi NC, Hirose H. Ventilator strategies for VV ECMO management with concomitant tracheal injury and H1N1 influenza. Heart Lung Vessel. 2015;7(1):74–80.PubMedPubMedCentral
30.
Zurück zum Zitat Kalbhenn J, Wittau N, Schmutz A, Zieger B, Schmidt R. Identification of acquired coagulation disorders and effects of target-controlled coagulation factor substitution on the incidence and severity of spontaneous intracranial bleeding during veno-venous ECMO therapy. Perfusion. 2015;30(8):675–82. https://doi.org/10.1177/0267659115579714.CrossRefPubMed Kalbhenn J, Wittau N, Schmutz A, Zieger B, Schmidt R. Identification of acquired coagulation disorders and effects of target-controlled coagulation factor substitution on the incidence and severity of spontaneous intracranial bleeding during veno-venous ECMO therapy. Perfusion. 2015;30(8):675–82. https://​doi.​org/​10.​1177/​0267659115579714​.CrossRefPubMed
Metadaten
Titel
The Role of Extracorporeal Life Support in Thoracic Surgery
verfasst von
Torsten Loop
Johannes Kalbhenn
Axel Semmelmann
Publikationsdatum
16.11.2019
Verlag
Springer US
Erschienen in
Current Anesthesiology Reports / Ausgabe 4/2019
Elektronische ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-019-00362-9

Weitere Artikel der Ausgabe 4/2019

Current Anesthesiology Reports 4/2019 Zur Ausgabe

Geriatric Anesthesia (S Akhtar, Section Editor)

Perioperative Acute Care of Older Patients Living with Frailty

Thoracic Anesthesia (T Schilling, Section Editor)

Hypoxemia During One-Lung Ventilation: Does it Really Matter?

Thoracic Anesthesia (T Schilling, Section Editor)

Pulmonary Hypertension and Thoracic Surgery: Impact and Treatment Options

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.