Operating Room-Complete Venovenous Extracorporeal Membrane Oxygenation for Thoracoscopic Surgery Without...

Patients who cannot sustain gas exchange during one-lung ventilation may still require a brief thoracoscopic procedure. Venovenous extracorporeal membrane oxygenation can support them, but conventional practice involves cannulating the supine patient and then turning them laterally while they are circuit-dependent. We describe an operating-room-complete strategy in which the semi-supine position is the single operative position: femoral access and video-assisted thoracoscopic surgery proceed without repositioning, with exposure adjusted by rotating the table. The vein is cannulated with a purse-string, permitting direct repair at decannulation. No heparin is given systemically or in the prime; antithrombogenicity relies on heparin-bonded surfaces, a flow of 2.5-3.5 L/min, brief support, and predefined rescue triggers. Between October 2022 and June 2025, the strategy was applied in five of 548 thoracoscopic procedures. Operative times were 124-172 min, and venovenous extracorporeal membrane oxygenation support was 27-69 min; all were weaned in the operating room without thromboembolic or hemorrhagic complications.