Veno-venous extra-corporeal membrane oxygenation in complex tracheobronchial resection

Area of Science:

• Thoracic Surgery
• Cardiopulmonary Support
• Airway Reconstruction

Background:

• Elective extra-corporeal membrane oxygenation (ECMO) is infrequently used in thoracic surgery, excluding lung transplantation.
• Veno-venous (VV) ECMO is an emerging support modality for complex airway procedures.

Purpose of the Study:

• To evaluate the institutional experience with intraoperative VV-ECMO in selected main airway surgeries.
• To assess the safety and efficacy of VV-ECMO in complex thoracic procedures.

Main Methods:

• Retrospective analysis of 10 patients undergoing main airway surgery with VV-ECMO support (June 2013 - August 2022).
• Procedures included carinal resection, sleeve lobectomy, tracheal repair, and resection for post-tracheostomy stenosis.

Main Results:

• Median intraoperative VV-ECMO use was 162.5 minutes.
• High-flow VV-ECMO enabled ventilation interruption for up to 3 hours in complex cases.
• No perioperative deaths or ECMO-related complications were observed.
• All 10 patients survived with a median follow-up of 30 months; one patient had a minor anastomotic complication.

Conclusions:

• Intraoperative VV-ECMO facilitates safe and precise main airway surgery, including complex resections and reconstructions.
• This technique is beneficial for patients unable to tolerate conventional ventilation.
• VV-ECMO use is associated with minimal postoperative morbidity and favorable long-term survival.