Skip to main content
SpringerLink
Log in

The Role of Extracorporeal Life Support in Thoracic Surgery

  • Thoracic Anesthesia (T Schilling, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Extracorporeal life support (ECLS) is a widely used potential treatment option in patients with severe respiratory or cardiac failure with increasing significance. Routine perioperative application of ECLS is applied in cardiac and rare in thoracic surgery. This review will address the extracorporeal membrane oxygenation (ECMO) technology and basic concepts, the indications in thoracic surgery, and the intraoperative management of ECMO during surgery. The most common challenges and complications, the postoperative concept, and additional forms of support will be discussed.

Recent Findings

Technological advances in ECMO components may allow complex thoracic surgical procedures in patients in whom one-lung ventilation cannot be carried out safely without risk of hypoxia or right ventricular failure.

Summary

The indications of ECLS in thoracic surgery besides lung transplantation are mainly airway resection and reconstructive surgery in patients with obstructive tracheobronchial airway diseases. Rare indications are lung surgery in patients with poor pulmonary reserve and difficulty or impossibility of one-lung ventilation. The intraoperative management of ECMO during thoracic surgery needs professional expertise.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Karagiannidis C, Brodie D, Strassmann S, Stoelben E, Philipp A, Bein T, et al. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016;42(5):889–96. https://doi.org/10.1007/s00134-016-4273-z. This retrospective study demonstrated the recent increase in ECMO utilization, which is associated with a reduction in the in-hospital mortality. Importantly, the overall mortality in ECMO patients, particularly in patients with short-term ECMO use and older patients, still remains high, which is in contrast to findings of prospective studies performed by highly experienced research groups.

  2. Rinieri P, Peillon C, Bessou JP, Veber B, Falcoz PE, Melki J, et al. National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation. Eur J Cardiothorac Surg. 2015;47(1):87–94. https://doi.org/10.1093/ejcts/ezu127.

    Article  PubMed  Google Scholar 

  3. Makdisi G, Makdisi PB, Wang IW. New horizons of non-emergent use of extracorporeal membranous oxygenator support. Ann Transl Med. 2016;4(4):76. https://doi.org/10.3978/j.issn.2305-5839.2016.02.04.

    Article  PubMed  PubMed Central  Google Scholar 

  4. • Rosskopfova P, Perentes JY, Ris HB, Gronchi F, Krueger T, Gonzalez M. Extracorporeal support for pulmonary resection: current indications and results. World J Surg Oncol. 2016;14:25. https://doi.org/10.1186/s12957-016-0781-0. This review reported the current experience of the different extracorporeal device available for the thoracic surgeon and clarify the different indications.

  5. •• Conrad SA, Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, et al. The extracorporeal life support organization maastricht treaty for nomenclature in extracorporeal life support. A position paper of the extracorporeal life support organization. Am J Respir Crit Care Med. 2018;198(4):447–51. https://doi.org/10.1164/rccm.201710-2130CP. Classification system for ECLS nomenclature which provides a standardized foundation for the description of ECLS application, decreasing ambiguity and providing consistency for the comparison of clinical reports.

  6. Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: a review. JAMA. 2019;322(6):557–68. https://doi.org/10.1001/jama.2019.9302.

    Article  PubMed  Google Scholar 

  7. McRae K, de Perrot M. Principles and indications of extracorporeal life support in general thoracic surgery. J Thorac Dis. 2018;10(Suppl 8):S931-S46. doi:https://doi.org/10.21037/jtd.2018.03.116.

  8. Jayaraman AL, Cormican D, Shah P, Ramakrishna H. Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: techniques, limitations, and special considerations. Ann Card Anaesth. 2017;20(Supplement):S11–S8. https://doi.org/10.4103/0971-9784.197791.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Benazzo A, Schwarz S, Frommlet F, Schweiger T, Jaksch P, Schellongowski P, et al. Twenty-year experience with extracorporeal life support as bridge to lung transplantation. J Thorac Cardiovasc Surg. 2019;157(6):2515–25 e10. https://doi.org/10.1016/j.jtcvs.2019.02.048.

    Article  PubMed  Google Scholar 

  10. Hoetzenecker K, Schwarz S, Muckenhuber M, Benazzo A, Frommlet F, Schweiger T, et al. Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation. J Thorac Cardiovasc Surg. 2018;155(5):2193–206 e3. https://doi.org/10.1016/j.jtcvs.2017.10.144.

    Article  PubMed  Google Scholar 

  11. Moser B, Jaksch P, Taghavi S, Murakozy G, Lang G, Hager H, et al. Lung transplantation for idiopathic pulmonary arterial hypertension on intraoperative and postoperatively prolonged extracorporeal membrane oxygenation provides optimally controlled reperfusion and excellent outcome. Eur J Cardiothorac Surg. 2018;53(1):178–85. https://doi.org/10.1093/ejcts/ezx212.

    Article  PubMed  Google Scholar 

  12. Rupprecht L, Lunz D, Philipp A, Lubnow M, Schmid C. Pitfalls in percutaneous ECMO cannulation. Heart Lung Vessel. 2015;7(4):320–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Kazmi SO, Sivakumar S, Karakitsos D, Alharthy A, Lazaridis C. Cerebral pathophysiology in extracorporeal membrane oxygenation: pitfalls in daily clinical management. Crit Care Res Pract. 2018;2018:3237810. https://doi.org/10.1155/2018/3237810.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Taghavi S, Jayarajan SN, Mangi AA, Hollenbach K, Dauer E, Sjoholm LO, et al. Examining noncardiac surgical procedures in patients on extracorporeal membrane oxygenation. ASAIO J. 2015;61(5):520–5. https://doi.org/10.1097/MAT.0000000000000258.

    Article  CAS  PubMed  Google Scholar 

  15. Ius F, Tudorache I, Warnecke G. Extracorporeal support, during and after lung transplantation: the history of an idea. J Thorac Dis. 2018;10(8):5131–48. https://doi.org/10.21037/jtd.2018.07.43.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Aigner C, Wisser W, Taghavi S, Lang G, Jaksch P, Czyzewski D, et al. Institutional experience with extracorporeal membrane oxygenation in lung transplantation. Eur J Cardiothorac Surg. 2007;31(3):468–73; discussion 73–4. https://doi.org/10.1016/j.ejcts.2006.11.049.

    Article  PubMed  Google Scholar 

  17. Xu L, Li X, Xu M, Gao C, Zhu J, Ji B. Perioperative use of ECMO during double lung transplantation. ASAIO J. 2009;55(3):255–8. https://doi.org/10.1097/MAT.0b013e3181a05795.

    Article  PubMed  Google Scholar 

  18. • Hoetzenecker K, Klepetko W, Keshavjee S, Cypel M. Extracorporeal support in airway surgery. J Thorac Dis. 2017;9(7):2108–17. doi:https://doi.org/10.21037/jtd.2017.06.17. This review described the published experience of ECLS in airway surgery both in adults and in pediatric patients. It highlights currently available devices and their indications.

  19. Lang G, Ghanim B, Hotzenecker K, Klikovits T, Matilla JR, Aigner C, et al. Extracorporeal membrane oxygenation support for complex tracheo-bronchial procedures†. Eur J Cardiothorac Surg. 2015;47(2):250–5; discussion 6. https://doi.org/10.1093/ejcts/ezu162.

    Article  PubMed  Google Scholar 

  20. Johnson AP, Cavarocchi NC, Hirose H. Ventilator strategies for VV ECMO management with concomitant tracheal injury and H1N1 influenza. Heart Lung Vessel. 2015;7(1):74–80.

    PubMed  PubMed Central  Google Scholar 

  21. Kim CW, Kim DH, Son BS, Cho JS, Kim YD. I H et al. The feasibility of extracorporeal membrane oxygenation in the variant airway problems. Ann Thorac Cardiovasc Surg. 2015;21(6):517–22. https://doi.org/10.5761/atcs.oa.15-00073.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Keeyapaj W, Alfirevic A. Carinal resection using an airway exchange catheter-assisted venovenous ECMO technique. Can J Anaesth. 2012;59(11):1075–6. https://doi.org/10.1007/s12630-012-9773-x.

    Article  PubMed  Google Scholar 

  23. Redwan B, Ziegeler S, Freermann S, Nique L, Semik M, Lavae-Mokhtari M, et al. Intraoperative veno-venous extracorporeal lung support in thoracic surgery: a single-centre experience. Interact Cardiovasc Thorac Surg. 2015;21(6):766–72. https://doi.org/10.1093/icvts/ivv253.

    Article  PubMed  Google Scholar 

  24. Grapatsas K, Schmid S, Haager B, Loop T, Passlick B. Short veno-venous extracorporeal membrane oxygenation assisted segmentectomy for second primary lung tumor in a patient with insufficient respiratory function for one lung ventilation. Respir Med Case Rep. 2018;24:176–8. https://doi.org/10.1016/j.rmcr.2018.05.027.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Felten ML, Michel-Cherqui M, Puyo P, Fischler M. Extracorporeal membrane oxygenation use for mediastinal tumor resection. Ann Thorac Surg. 2010;89(3):1012. https://doi.org/10.1016/j.athoracsur.2009.09.064.

    Article  PubMed  Google Scholar 

  26. Thiagarajan RR, Barbaro RP, Rycus PT, McMullan DM, Conrad SA, Fortenberry JD, et al. Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63(1):60–7. https://doi.org/10.1097/MAT.0000000000000475.

    Article  PubMed  Google Scholar 

  27. Aubron C, DePuydt J, Belon F, Bailey M, Schmidt M, Sheldrake J, et al. Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation. Ann Intensive Care. 2016;6(1):97. https://doi.org/10.1186/s13613-016-0196-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Cavayas YA, Del Sorbo L, Fan E. Intracranial hemorrhage in adults on ECMO. Perfusion. 2018;33(1_suppl):42–50. doi:https://doi.org/10.1177/0267659118766435.

  29. Kalbhenn J, Schlagenhauf A, Rosenfelder S, Schmutz A, Zieger B. Acquired von Willebrand syndrome and impaired platelet function during venovenous extracorporeal membrane oxygenation: rapid onset and fast recovery. J Heart Lung Transplant. 2018;37(8):985–91. https://doi.org/10.1016/j.healun.2018.03.013.

    Article  PubMed  Google Scholar 

  30. Kalbhenn J, Wittau N, Schmutz A, Zieger B, Schmidt R. Identification of acquired coagulation disorders and effects of target-controlled coagulation factor substitution on the incidence and severity of spontaneous intracranial bleeding during veno-venous ECMO therapy. Perfusion. 2015;30(8):675–82. https://doi.org/10.1177/0267659115579714.

    Article  CAS  PubMed  Google Scholar 

  31. Krueger K, Schmutz A, Zieger B, Kalbhenn J. Venovenous extracorporeal membrane oxygenation with prophylactic subcutaneous anticoagulation only: an observational study in more than 60 patients. Artif Organs. 2017;41(2):186–92. https://doi.org/10.1111/aor.12737.

    Article  CAS  PubMed  Google Scholar 

  32. Broman LM, Malfertheiner MV, Montisci A, Pappalardo F. Weaning from veno-venous extracorporeal membrane oxygenation: how I do it. J Thorac Dis. 2018;10(Suppl 5):S692-S7. doi:https://doi.org/10.21037/jtd.2017.09.95.

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, Freiburg im Breisgau, Germany

    Torsten Loop & Axel Semmelmann

Authors
  1. Torsten Loop
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johannes Kalbhenn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Axel Semmelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Torsten Loop.

Ethics declarations

Conflict of Interest

Torsten Loop, Johannes Kalbhenn, and Axel Semmelmann declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors..

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Thoracic Anesthesia

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Loop, T., Kalbhenn, J. & Semmelmann, A. The Role of Extracorporeal Life Support in Thoracic Surgery. Curr Anesthesiol Rep 9, 430–435 (2019). https://doi.org/10.1007/s40140-019-00362-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40140-019-00362-9

Keywords

Search

Navigation