Department of Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, Chengdu, China.
Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
Ann Thorac Cardiovasc Surg. 2020 Dec 20;26(6):327-331. doi: 10.5761/atcs.oa.20-00005. Epub 2020 May 29.
Patients who require surgeries for traumatic post-tracheotomy tracheal stenosis (PTTS) often cannot be supported using conventional airway management approaches. This study documents the use of extracorporeal membrane oxygenation (ECMO) in patients with PTTS.
Patient characteristics, procedure, and outcome of patients who required tracheal reconstruction surgery for PTTS supported by ECMO were retrieved and analyzed.
Four patients (mean age 28 years; range 17-48 years) with traumatic PTTS underwent tracheal reconstruction surgery supported by ECMO. The mean time from removal of tracheotomy tube to admission was 3.2 months (range: 1-9 months). The mean diameter of the stenotic segment was 5 mm (range: 4-6 mm). One patient underwent tracheoplasty and semi-tracheostomy with venoarterial ECMO urgently. Three patients underwent tracheal resection and end-to-end anastomosis (TRE) with venovenous ECMO empirically. Intervention success was achieved in 100% (4/4) of patients. The mean duration of ECMO was 35.3 hours (range: 16-53 hours). The overall survival rate was 100% (4/4) within a mean follow-up of 26 months (range: 7-57 months).
ECMO is a safe and feasible method to support oxygenation for patients with critical traumatic PTTS during tracheal reconstruction surgery.
需要手术治疗创伤性气管切开后气管狭窄（PTTS）的患者通常无法采用常规气道管理方法进行支持。本研究记录了体外膜肺氧合（ECMO）在 PTTS 患者中的应用。
检索并分析了接受 ECMO 支持的 PTTS 患者行气管重建手术的患者特征、手术过程和结局。
4 名（平均年龄 28 岁；范围 17-48 岁）创伤性 PTTS 患者接受 ECMO 支持的气管重建手术。从气管切开管拔出到入院的平均时间为 3.2 个月（范围：1-9 个月）。狭窄段的平均直径为 5 毫米（范围：4-6 毫米）。1 名患者紧急行气管成形术和半气管切开术联合静脉-动脉 ECMO。3 名患者行气管切除术和端端吻合术（TRE）联合静脉-静脉 ECMO 经验性治疗。100%（4/4）的患者获得了介入成功。ECMO 的平均使用时间为 35.3 小时（范围：16-53 小时）。平均 26 个月（范围：7-57 个月）的随访中，总体生存率为 100%（4/4）。
ECMO 是一种安全可行的方法，可在气管重建手术期间为患有严重创伤性 PTTS 的患者提供氧合支持。
