Feasibility of extracorporeal membrane oxygenation in high-risk thoracic surgery

Abstract

Objective: The feasibility of extracorporeal membrane oxygenation (ECMO) as intraoperative cardiorespiratory support during lung transplantation and tracheobronchial surgery is well known, but studies on its use for other types of surgery are limited. To assess the feasibility of ECMO in high-risk thoracic surgery, we reviewed surgeries in which ECMO was used.

Methods: Between January 2011 and October 2018, 63 patients were supported on ECMO during thoracic surgery performed for severe airway disease, pulmonary insufficiency requiring lung surgery, and other conditions that can cause cardiac arrest during surgery.

Results: Forty-six patients remained alive at 30 days after surgery. The mean patient age was 50.38 ± 16.16 years (survival group (S) vs non survival group (N): 47.4 ± 15.8 vs 58.35 ±14.7, p = 0.016). ECMO was most commonly used to prevent a lethal event (34 [73.9%]) in the Survival group and as a rescue intervention (13 [76.5%]) in the Non-survival group. There were significant intergroup differences. Eleven patients experienced arrest during surgery (S vs N: 2 [4.3%] vs 9 [52.9%], p ≤ 0.001). The multivariate analysis revealed that perioperative arrest (odds ratio, 24.44; 95% confidence interval, 1.82–327.60; p = 0.016) and age (odds ratio, 7.47; 95% confidence interval, 1.17–47.85; p = 0.034) were independently associated with mortality.

Conclusions: ECMO provides a safe environment during thoracic surgery, and its complication rate is acceptable except for extracorporeal cardiopulmonary resuscitation. The planned use of ECMO in a well-planned operation is highly recommended in high-risk thoracic surgery.