Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Division of Thoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Artif Organs. 2022 Mar;46(3):362-374. doi: 10.1111/aor.14084. Epub 2021 Nov 16.
Major airway surgery can pose a complex problem to perioperative central airway management. Adjuncts to advanced ventilation strategies have included cardiopulmonary bypass, veno-arterial, or veno-venous extracorporeal life support. We performed a systematic review to assess the existing evidence utilizing these strategies.
An electronic search was conducted to identify studies written in English reporting the use of extracorporeal life support (ECLS) during central airway surgery. Thirty-six articles consisting of 78 patients were selected and patient-level data were analyzed.
Median patient age was 47 [IQR: 34-53] and 59.0% (46/78) were male. Indications for surgery included central airway or mediastinal cancer in 57.7% (45/78), lesion or injury in 15.4% (12/78), and stenosis in 12.8% (10/78). Support was initiated pre-operatively in 9.9% (7/71) and at the time of induction in 55.3% (42/76). It was most commonly used at the time of tracheal resection/repair [93.2% (68/73)], intubation of the tracheal stump [94.4% (68/72)], and re-anastomosis [94.2% (65/69)]; 13.7% (10/73) patients were supported post-operatively. The most commonly performed surgery was tracheal repair or resection in 70.3% (52/74). Median hospital stay was 12 [8, 25] days and in-hospital mortality was 7.9% (6/76). There was no significant difference in survival between the three groups (p = .54).
Extracorporeal membrane oxygenation offers versatility in timing, surgical approach, and ECLS runtime that makes it a viable addition to the surgical armamentarium for treating complex central airway pathologies.
大气道手术可能给围手术期中央气道管理带来复杂的问题。辅助高级通气策略包括体外心肺旁路、动静脉或静脉-静脉体外生命支持。我们进行了系统评价，以评估利用这些策略的现有证据。
进行电子检索，以确定以英文报告在中央气道手术中使用体外生命支持（ECLS）的研究。选择了 36 篇文章，共 78 例患者，并对患者水平数据进行了分析。
中位患者年龄为 47 [IQR：34-53]，59.0%（46/78）为男性。手术指征包括中央气道或纵隔癌 57.7%（45/78），病变或损伤 15.4%（12/78），狭窄 12.8%（10/78）。71 例患者中有 9.9%（7/71）在术前开始支持，76 例中有 55.3%（42/76）在诱导时开始支持。最常用于气管切除/修复时[93.2%（68/73）]、气管残端插管时[94.4%（68/72）]和重新吻合时[94.2%（65/69）]；73 例中有 13.7%（10/73）患者在术后接受支持。最常进行的手术是气管修复或切除，占 70.3%（52/74）。中位住院时间为 12 [8，25]天，院内死亡率为 7.9%（6/76）。三组之间的生存率无显著差异（p=0.54）。
体外膜氧合在时间、手术方法和 ECLS 运行时间方面具有多样性，使其成为治疗复杂中央气道病变的手术武器库的可行补充。
