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Elective extracorporeal support for complex tracheal reconstruction in neonates
Michael H Hines1, Douglas R Hansell
1Departments of Cardiothoracic Surgery and Extracorporeal Support Services, Brenner Children's Hospital, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. mhines@wfubmc.edu
The Annals of Thoracic Surgery
|July 5, 2003
Summary
Extracorporeal membrane oxygenation (ECMO) facilitates complex tracheal reconstruction in newborns, improving surgical exposure and promoting excellent airway healing. This technique minimizes trauma, enhancing recovery for infants with congenital tracheal anomalies.
Area of Science:
- Pediatric Surgery
- Cardiothoracic Surgery
- Neonatology
Background:
- Congenital tracheal anomalies pose significant surgical and airway management challenges.
- Complications include anastomotic breakdown, leaks, and granulation tissue formation.
- Extracorporeal support offers a novel approach to improve surgical outcomes.
Purpose of the Study:
- To describe a technique using elective intraoperative and postoperative extracorporeal support for complex tracheal reconstructions.
- To evaluate the safety and efficacy of this approach in improving surgical exposure and postoperative healing.
Main Methods:
- Four newborns with long segment tracheal stenosis or complete tracheal rings underwent complex tracheal reconstruction.
- Repairs were performed via median sternotomy with extracorporeal membrane oxygenation (ECMO) support (venoarterial then venovenous).
- Postoperative management included 'airway rest' with ECMO, followed by lung reexpansion and ventilation.
Main Results:
- All patients exhibited excellent tracheal healing without granulation tissue or ECMO complications.
- Two patients survived long-term; two late deaths occurred due to comorbidities.
- Two infants required late tracheostomy due to associated facial and laryngeal anomalies.
Conclusions:
- Extracorporeal membrane oxygenation provides an optimal environment for complex tracheal reconstruction.
- ECMO promotes superior postoperative healing by minimizing airway trauma.
- This technique enhances outcomes for neonates undergoing challenging tracheal repairs.