Heward Elliot, Hashmi Syed F, Malagon Ignacio, Shah Rajesh, Barker Julian, Rammohan Kandadai S
Department of Cardiothoracic Surgery, 5295 University Hospital of South Manchester , Manchester, UK.
Asian Cardiovasc Thorac Ann. 2018 Mar;26(3):183-187. doi: 10.1177/0218492318760710. Epub 2018 Feb 14.
Background Recent evidence surrounding the use of venovenous extracorporeal membrane oxygenation in treating acute respiratory failure has led to the expansion of extracorporeal membrane oxygenation services worldwide. The high rate of complications related to venovenous extracorporeal membrane oxygenation often requires intervention by specialist thoracic surgeons. This study aimed to investigate the role of specialist thoracic surgeons within the multidisciplinary team managing these high-risk patients. Methods We retrospectively reviewed 90 patients who received venovenous extracorporeal membrane oxygenation at our tertiary referral center between December 2011 and May 2015. Four patients who underwent lung transplantation were excluded. Results We found that 29.1% (25/86) of patients on venovenous extracorporeal membrane oxygenation had undergone a thoracic intervention. A total of 82 interventions were performed: 11 thoracotomies, 49 chest drains, 13 rigid bronchoscopies, 4 flexible bronchoscopies, 4 temporary endobronchial blockers, and 1 sternotomy. Of the 11 thoracotomies, 3 were reexplorations. Survival to discharge for patients who underwent thoracic surgical interventions was 72% (18/25). Conclusions Our experience has demonstrated that a large proportion of patients receiving venovenous extracorporeal membrane oxygenation require a thoracic intervention, many of which are major intraoperative procedures. Patients on venovenous extracorporeal membrane oxygenation have benefited from rapid on-site access to thoracic surgical services to manage these challenging life-threatening complications.
背景 近期有关静脉-静脉体外膜肺氧合用于治疗急性呼吸衰竭的证据促使全球范围内体外膜肺氧合服务的扩展。与静脉-静脉体外膜肺氧合相关的高并发症发生率常常需要胸外科专科医生进行干预。本研究旨在调查胸外科专科医生在管理这些高危患者的多学科团队中的作用。方法 我们回顾性分析了2011年12月至2015年5月期间在我们的三级转诊中心接受静脉-静脉体外膜肺氧合的90例患者。4例接受肺移植的患者被排除。结果 我们发现接受静脉-静脉体外膜肺氧合的患者中有29.1%（25/86）接受了胸科干预。共进行了82次干预：11次开胸手术、49次胸腔引流、13次硬质支气管镜检查、4次柔性支气管镜检查、4次临时支气管内封堵和1次胸骨切开术。在11次开胸手术中，3次是再次探查。接受胸外科手术干预的患者出院生存率为72%（18/25）。结论 我们的经验表明，接受静脉-静脉体外膜肺氧合的患者中有很大一部分需要胸科干预，其中许多是重大的术中操作。接受静脉-静脉体外膜肺氧合的患者受益于能够迅速获得胸外科服务以处理这些具有挑战性的危及生命的并发症。
