Complex pulmonary resections using extracorporeal membrane oxygenation

Aris Koryllos, Alberto Lopez-Pastorini, Erich Stoelben

Abstract

Background: The use and effect of extracorporeal membrane oxygenation (ECMO) in general thoracic surgery patients is still not clear. Although ECMO is being routinously used in lung transplantation patients, it’s benefits in oncological patients are still to be defined.
Methods: In a period of 8 years, a total of 24 patients underwent complex lung resections under ECMO in our institution. In cases of carinal resection, percutaneous veno-venous, jugular-femoral cannulation (VV-ECMO) was considered suitable. For combined resection of lung a descending aorta a percutaneous femoral veno-arterial cannulation was used (VA-ECMO). In cases of extended left atrial resection, a percutaneous jugular-femoral veno-venous-arterial cannulation was favoured (VV-A-ECMO).
Results: Carinal resections and reconstruction (n=8), resections of the descending aorta and left lung (n=7), resections of lung and left atrium (n=9). No intraoperative deaths occurred. Overall 30-day mortality was 25%. A complete resection was achieved in 18 patients.
Conclusions: In conclusion, the present study shows that intraoperative use of ECMO in oncological general thoracic surgery patients is feasible, with minimal intraoperative complications allowing surgeons increased operating-field safety. Perioperative mortality is high, but this is rather an attribute of local extended disease and patient comorbidities.