Horita K, Cao Z L, Itoh T
Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Nabeshima, Japan.
Chest. 1998 Jul;114(1):229-35. doi: 10.1378/chest.114.1.229.
Although the indications for extracorporeal membrane oxygenation (ECMO) have been extended, ECMO has yet to be used as a respiratory support system during thoracic surgery. The purpose of this experimental study was to investigate whether veno-right ventricular (veno-RV) ECMO can be used for thoracic surgery without mechanical ventilation.
Acute experimental study: Veno-RV ECMO as total lung support was maintained for 60 min without mechanical ventilation in six dogs. A venous drainage cannula was inserted in the superior cavoatrial junction through the right femoral vein and a venous return cannula was inserted in the right ventricle through the right jugular vein. The veno-RV ECMO system comprised a centrifugal pump and membrane oxygenator. Survival model: After veno-RV ECMO had been established in three dogs, a two-ring thoracic tracheal segment was resected and the tracheal ends were anastomosed by video-assisted thoracic surgery without ventilation.
In the acute study, when the veno-RV ECMO flow was maintained at 100 mL/kg/min, all six dogs remained hemodynamically stable and the arterial oxygen saturation was maintained at more than 98%, despite total lung collapse. In the survival study, all three dogs made an uneventful postoperative recovery.
Video-assisted tracheal surgery can be performed without conventional respiratory support. Veno-RV ECMO as total lung support may become an alternative respiratory management device for thoracic surgery.
尽管体外膜肺氧合（ECMO）的适应证已经扩大，但ECMO尚未在胸外科手术中用作呼吸支持系统。本实验研究的目的是探讨静脉-右心室（veno-RV）ECMO是否可在无机械通气的情况下用于胸外科手术。
急性实验研究：在6只犬中，在无机械通气的情况下，将veno-RV ECMO作为全肺支持维持60分钟。通过右股静脉在右上腔静脉交界处插入一根静脉引流套管，并通过右颈静脉在右心室插入一根静脉回流套管。veno-RV ECMO系统包括一个离心泵和一个膜式氧合器。生存模型：在3只犬建立veno-RV ECMO后，切除一个两环胸段气管，通过电视辅助胸腔手术在无通气的情况下吻合气管两端。
在急性研究中，当veno-RV ECMO流量维持在100 mL/kg/min时，尽管全肺萎陷，所有6只犬的血流动力学仍保持稳定，动脉血氧饱和度维持在98%以上。在生存研究中，所有3只犬术后恢复顺利。
电视辅助气管手术可在无传统呼吸支持的情况下进行。veno-RV ECMO作为全肺支持可能成为胸外科手术中一种替代的呼吸管理设备。
