Extracorporeal Membrane Oxygenation-Assisted Thoracic Surgery: A Series of 10 Cases.

IF 0.7 Q4 SURGERY
Surgical Case Reports Pub Date : 2025-01-01 Epub Date: 2025-03-15 DOI:10.70352/scrj.cr.24-0004
Yuzu Harata, Kazuhiro Imai, Shinogu Takashima, Shoji Kuriyama, Hidenobu Iwai, Haruka Suzuki, Ryo Demura, Sumire Shibano, Yoshihiro Minamiya
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引用次数: 0

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is a type of extracorporeal circulation used to divert blood from and deliver blood to peripheral blood vessels. Recently, the use of ECMO has been reported in various non-transplant surgeries. Particularly in tracheal surgeries, ECMO provides an unobstructed surgical field and enables safe induction of general anesthesia in difficult intubation cases. Here, we report on 10 cases of thoracic surgery in which ECMO was employed at our institution.

Case presentation: These 10 cases comprise 4 tracheal cancer surgeries, 2 lung cancer surgeries, and 1 case each of surgery for thyroid cancer, mediastinal cancer, tracheomalacia, and tracheobronchial injury. Veno-venous (VV)-ECMO is most often selected, but veno-arterial (VA)-ECMO is chosen when recirculation with VV-ECMO is unacceptable, when pulmonary artery bleeding needs to be controlled, or when cardiac support is necessary. Among the 10 presented cases, VV-ECMO was used in 8, while VA-ECMO was employed in 2. Three of these cases involved ECMO bailout due to dyspnea caused by airway stenosis. Six of the patients did not receive heparin maintenance. Of those, 1 was maintained on nafamostat mesilate, 2 were maintained on nafamostat mesilate after receiving a single dose of heparin, and 3 received only a single dose of heparin. In none of those cases did ECMO fail to maintain flow due to thrombus formation. A postoperative hemothorax occurred as one of the ECMO-related complications in Case 4. There were no perioperative cardiopulmonary complications, in-hospital deaths, or deaths within 30 days after surgery. One patient died from metastatic recurrence of non-small cell lung cancer 5 months after surgery, another from progression of disease in mediastinal anaplastic cancer 4 months after surgery, and the 3rd from upper gastrointestinal bleeding 2 years after surgery. The other 7 patients remain alive.

Conclusions: ECMO is useful in tracheal surgery and in cases where intubation is difficult or dangerous, because it facilitates safe and accurate surgery. We also believe that individualized anticoagulant strategies can be safely implemented.

体外膜氧合辅助胸外科手术:附10例报告。
体外膜氧合(Extracorporeal membrane oxygenation, ECMO)是一种体外循环,用于将血液从外周血管转移和输送到外周血管。最近,ECMO已被报道用于各种非移植手术。特别是在气管手术中,ECMO提供了一个通畅的手术野,在插管困难的情况下可以安全诱导全身麻醉。在这里,我们报告了10例胸外科手术中ECMO在我们机构的应用。病例介绍:10例中,气管癌手术4例,肺癌手术2例,甲状腺癌、纵隔癌、气管软化、气管支气管损伤各1例。静脉-静脉(VV)-ECMO最常被选择,但当静脉-动脉(VA)-ECMO再循环与VV-ECMO是不可接受的,当肺动脉出血需要控制,或当心脏支持是必要的。10例患者中,VV-ECMO 8例,VA-ECMO 2例。其中3例因气道狭窄引起的呼吸困难涉及ECMO救助。6例患者未接受肝素维持治疗。其中,1人在接受单剂量肝素治疗后继续服用甲磺酸那莫他,2人在接受单剂量肝素治疗后继续服用甲磺酸那莫他,3人只接受单剂量肝素治疗。在这些病例中,没有一例由于血栓形成而ECMO不能维持血流。病例4发生ecmo并发症之一的术后血胸。无围手术期心肺并发症、院内死亡或术后30天内死亡。1例患者术后5个月死于非小细胞肺癌转移复发,1例患者术后4个月死于纵隔间变性癌进展,3例患者术后2年死于上消化道出血。其他7名患者仍然活着。结论:ECMO在气管手术和插管困难或危险的情况下是有用的,因为它有助于安全准确的手术。我们也相信个体化抗凝策略可以安全地实施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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