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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
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[Extracorporeal Membrane Oxygenation in Thoracic Surgery: the Anesthesiologist's Perspective]
Stephanie Rehers1, Martin Beiderlinden2, Stephan Ziegeler1
1Anästhesie, operative Intensivmedizin, Schmerztherapie und Notfallmedizin, Klinikum Ibbenbüren, Deutschland.
Zentralblatt Fur Chirurgie
|January 9, 2019
Summary
Enhanced Recovery after Surgery programs in thoracic surgery benefit from protective ventilation. Veno-venous membrane oxygenation (vvECMO) safely supports patients with severe lung limitations during surgery and aids postoperative recovery.
Area of Science:
- Cardiothoracic Surgery
- Anesthesiology
- Respiratory Physiology
Background:
- Enhanced Recovery after Surgery (ERAS) programs are increasingly adopted in thoracic surgery.
- Optimizing anesthetic techniques, including regional analgesia and protective ventilation, is crucial for ERAS.
- Severe pulmonary dysfunction poses challenges for protective ventilation during one-lung ventilation in thoracic procedures.
Purpose of the Study:
- To evaluate the utility of veno-venous membrane oxygenation (vvECMO) in managing patients undergoing thoracic surgery with pre-existing severe pulmonary limitations.
- To explore the role of vvECMO in facilitating perioperative treatment and postoperative recovery in this patient cohort.
Main Methods:
- Implementation of vvECMO during thoracic surgery for patients with severe pulmonary compromise.
- Perioperative management strategies including intraoperative heparin-coated circuits (if no anticoagulation needed) and postoperative anticoagulation options (heparin, argatroban, bivalirudin).
- Postoperative continuation of vvECMO to support therapeutic interventions like physical therapy and early mobilization.
Main Results:
- Veno-venous membrane oxygenation (vvECMO) is a safe and effective method for perioperative gas exchange management in high-risk thoracic surgery patients.
- Continued vvECMO postoperatively aids in healing air leaks and enhances the efficacy of rehabilitation therapies.
- Anticoagulation strategies can be tailored to minimize bleeding risks, with heparin-coated circuits offering an intraoperative option.
Conclusions:
- Veno-venous membrane oxygenation (vvECMO) is a valuable tool for enhancing perioperative care in thoracic surgery patients with severe pulmonary limitations.
- vvECMO facilitates the integration of protective ventilation strategies and supports early recovery interventions.
- Future advancements may involve utilizing vvECMO for minimally invasive thoracic surgery under regional anesthesia.
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