Early venovenous extracorporeal membrane oxygenation for idiopathic post-pneumonectomy pulmonary edema

Abstract

Introduction: Idiopathic post-pneumonectomy pulmonary edema (iPPE) is a rare but extremely severe complication of thoracic surgery. Mortality can reach 100 % especially after right pneumonectomy.

Objective: This study aimed to report the results of a strategy of early venovenous extracorporeal membrane oxygenation (vvECMO) in iPPE and to compare the results with those observed during a previous 6 years control period.

Methods: Since October 2010 , all patients diagnosed as iPPE were treated with early vvECMO associated with ultraprotective mechanical ventilation. Outcomes were compared with iPPE patients treated with conventional mechanical ventilation over the 2004-2010 period.

Results: Between October 2010 and December 2017, 150 pneumonectomies were performed ; 6 (mean age = 59.6 y ; 4 right pneumonectomies) patients developped iPPE and were treated with early vvECMO (mean time to ECMO = 3 days after surgery, range: 2 to 6 days) Mean durations of ECMO, mechanical ventilation and ICU stay were 8.6, 31.3, 39.2 days respectively. All patients survived and could be discharged from hospital. Four patients experienced a complication directly related to the vvECMO (major hemorrhage, n = 1 ; bacteremia with septic shock, n = 1 ; deep venous thrombosis, n = 2). During the control period 5 iPPE (mean age = 69 yrs ; 4 right pneumonectomies) occurred among 218 patients. All patients died during their ICU stay after a mean duration of 8.5 days.

Conclusion: This study suggests that early vvECMO should be considered as a life-saving therapy in iPPE .