The role of extracorporeal membrane oxygenation in thoracic surgery—a narrative review

Abstract

Background and Objective: Thoracic surgical patients provide unique challenges which can make maintaining adequate ventilation difficult or impossible. Despite advances in anaesthetic technique there are situations where other methods must be employed. The aim of this review is to provide an overview of extracorporeal membrane oxygenation (ECMO) and how it can be utilised in thoracic surgical patients. Methods: Library searches of PubMed ® and EMBASE databases were carried out to identify literature for inclusion in this review. Timeframe for consideration was from origin to 5/1/22. No restrictions were made on the basis of language. Content and Findings: ECMO has traditionally been used in emergency settings to manage severe respiratory or haemodynamic failure refractory to conventional medical therapy. In recent years there has been an expansion in the use of this technology beyond these settings, and it is increasingly being used in a range of emergency and elective thoracic surgical patients. The configuration of the ECMO circuit, and it’s duration of use are determined by the clinical need. The use of ECMO is associated with significant complications therefore its use requires careful consideration by an experienced multidisciplinary team. Complications can be related to the underlying pathology and patient related factors, or due to circuit related factors and the duration of use. Conclusions: The use of ECMO in thoracic surgery is rare and thus the evidence base is limited. As its use in thoracic surgical patients continues to increase, there is clear need for randomised trials to demonstrate the benefit of this technology in this complex group of patients.