Zhang Yan, Luo Ming, Wang Bo, Qin Zhen, Zhou Ronghua
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.
Perfusion. 2022 Sep;37(6):590-597. doi: 10.1177/02676591211011044. Epub 2021 Apr 28.
Extracorporeal membrane oxygenation (ECMO) is increasingly used in patients undergoing complex thoracic surgical procedures. However, studies reporting the clinical outcomes of these patients are limited to case reports, without real consensus. Our aim was to evaluate the perioperative use of ECMO as respiratory and/or circulatory support in thoracic surgery: indications, benefits, and perioperative management.
Between May 2013 and December 2018, we reviewed the clinical data of 15 patients (11 males and 4 females; mean age: 47 years old; range, 25-73 years) undergoing ECMO-assisted thoracic surgery in our hospital.
Of the 15 patients, 10 cases received peripheral veno-arterial (VA) ECMO and five cases received veno-venous (VV) ECMO. Indications for ECMO were pulmonary transplantation with hard-to-maintain oxygenation (n = 5), traumatic main bronchial rupture (n = 2), traumatic lung injury (n = 1), airway tumor leading to severe airway stenosis (n = 2), huge thoracic mass infiltrated vena cava (n = 5). The ECMO duration was 1-51 hours. All patients were successfully extubated and weaned from ECMO postoperatively. The main complications were hemorrhage (26.7%), infection (33.3%), acute hepatic dysfunction (33.3%), and venous thrombosis (26.7%). There was only one hospital death and postoperative one-year survival rate was 86%.
Our experience indicates that ECMO is a feasible method for complex trachea-bronchial surgery, huge thoracic mass excision and lung transplantation, and the ECMO-related risks may be justified. With further accumulation of experience with ECMO, a more sophisticated protocol for management of critical airway or heart failure problems in thoracic surgeries can be derived.
体外膜肺氧合（ECMO）在接受复杂胸外科手术的患者中应用越来越广泛。然而，报道这些患者临床结局的研究仅限于病例报告，尚无真正的共识。我们的目的是评估ECMO在胸外科手术中作为呼吸和/或循环支持的围手术期应用：适应证、益处及围手术期管理。
2013年5月至2018年12月，我们回顾了我院15例接受ECMO辅助胸外科手术患者的临床资料（11例男性，4例女性；平均年龄：47岁；范围25 - 73岁）。
15例患者中，10例接受外周静脉 - 动脉（VA）ECMO，5例接受静脉 - 静脉（VV）ECMO。ECMO的适应证为肺移植伴难以维持的氧合（n = 5）、创伤性主支气管破裂（n = 2）、创伤性肺损伤（n = 1）、气道肿瘤导致严重气道狭窄（n = 2）、巨大胸内肿物侵犯腔静脉（n = 5）。ECMO持续时间为1 - 51小时。所有患者术后均成功拔管并撤离ECMO。主要并发症为出血（26.7%）、感染（33.3%）、急性肝功能障碍（33.3%）和静脉血栓形成（26.7%）。仅1例医院死亡，术后1年生存率为86%。
我们的经验表明，ECMO是复杂气管 - 支气管手术、巨大胸内肿物切除及肺移植的可行方法，且与ECMO相关的风险可能是合理的。随着ECMO经验的进一步积累，可得出更完善的胸外科严重气道或心力衰竭问题管理方案。
