Extracorporeal Membrane Oxygenation Use in Thoracic Surgery

Area of Science:

• Cardiovascular and Thoracic Surgery
• Respiratory Medicine
• Critical Care Medicine

Background:

• Conventional ventilation is often insufficient for complex thoracic surgeries.
• Extracorporeal membrane oxygenation (ECMO) offers a potential solution for patients requiring advanced respiratory support.
• Its application in thoracic surgery, excluding lung transplantation, is a developing area.

Purpose of the Study:

• To review the application of ECMO in thoracic surgery (excluding lung transplantation).
• To discuss ECMO's role in complex procedures like sleeve lobectomies, pneumonectomies, and tracheal/carinal reconstructions.
• To explore perioperative management and outcomes associated with ECMO use in this context.

Main Methods:

• Narrative review of existing literature.
• Analysis of ECMO configurations and management strategies (anticoagulation, anesthesia).
• Inclusion of case studies and published series on perioperative ECMO use.

Main Results:

• ECMO facilitates thoracic surgeries not feasible with conventional ventilation.
• It is particularly useful in single-lung procedures and complex airway reconstructions.
• The review examines challenges such as hypoxemia and postoperative respiratory failure.

Conclusions:

• ECMO is a valuable tool for select thoracic surgical procedures.
• Careful management of anticoagulation, anesthesia, and potential complications is crucial.
• Further research and case series are needed to fully establish ECMO's role in thoracic surgery.