Park Jung-Hoon, Shin Ji Hoon, Kim Kun Yung, Lim Ju Yong, Kim Pyeong Hwa, Tsauo Jiaywei, Kim Min Tae, Song Ho-Young
Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.
Departments of Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.
J Thorac Dis. 2017 Aug;9(8):2599-2607. doi: 10.21037/jtd.2017.06.88.
Venovenous extracorporeal membrane oxygenation (VV ECMO) is used to support gas transfer of patients suffering from respiratory failure during various procedures. The purpose of this study was to evaluate the technical feasibility and safety of fluoroscopic stent placement under respiratory support with VV ECMO in patients with critical airway obstructions.
We reviewed the records of 17 patients (14 male and 3 female; mean age: 63 years; range, 30-82 years) who underwent self-expandable metallic stent (SEMS) placement under VV ECMO respiratory support for critical airway obstruction caused by malignant (n=16) or benign (n=1) etiology.
Fluoroscopic placement of SEMS was successful in all patients (100%) with no procedure-related complications. During a mean follow-up of 83 days (range, 10-367 days), 15 (88.2%) of 17 patients showed improvement of Hugh-Jones grades (from 4.7±0.4 to 3.1±0.9, P<0.001). Removal of the endotracheal tube was possible in 11 (84.6%) of 13 patients. Weaning off ECMO was successful in all patients. The ECMO-related and stent-related complication rates were 11.7% (n=2) and 29.4% (n=5), respectively, all successfully managed by additional interventions. Indications for VV ECMO included failure of mechanical ventilation in 13 (76.5%) patients, and orthopnea in 4 (23.5%) patients.
Fluoroscopic stent placement under VV ECMO respiratory support can be successfully performed in patients with critical airway obstruction, especially in cases of respiratory distress despite ventilation support and an inability to lie in a supine position. However, further studies will be needed to validate the standardized methods and specific indications.
静脉-静脉体外膜肺氧合（VV ECMO）用于在各种手术过程中支持呼吸衰竭患者的气体交换。本研究的目的是评估在VV ECMO呼吸支持下，对严重气道阻塞患者进行透视引导下支架置入术的技术可行性和安全性。
我们回顾了17例患者（14例男性和3例女性；平均年龄：63岁；范围30 - 82岁）的记录，这些患者因恶性（n = 16）或良性（n = 1）病因导致严重气道阻塞，在VV ECMO呼吸支持下接受了自膨式金属支架（SEMS）置入术。
所有患者（100%）透视引导下SEMS置入均成功，无手术相关并发症。在平均83天（范围10 - 367天）的随访期间，17例患者中有15例（88.2%）Hugh-Jones分级改善（从4.7±0.4降至3.1±0.9，P<0.001）。13例患者中有11例（84.6%）成功拔除气管插管。所有患者撤机均成功。ECMO相关和支架相关并发症发生率分别为11.7%（n = 2）和29.4%（n = 5），所有并发症均通过额外干预成功处理。VV ECMO的适应证包括1
