Awake Thoracic Surgery with Extracorporeal Membrane Oxygenation

Abstract

A 75-year old patient with a right sided secondary pneumothorax and prolonged air leak showed upper lobe predominant bullous emphysema. Due to the patients extremely reduced general condition neither an open approach nor a thoracoscopic approach seemed possible. Hence, we performed an awake lung volume reduction surgery with perioperative single site veno-venous extracorporeal membrane oxygenation. No heparin was administered. The extracorporeal membrane oxygenation (ECMO) could be weaned up to the second postoperative day. The further postoperative course was uneventful. This current case suggests that combining awake surgery with extracorporeal membrane oxygenation could be a future concept in extremely compromised patients.

Extracorporeal Oxygenation Techniques in Adult Critical Airway Obstruction: A Review

“…Extracorporeal oxygenation has been used in one case of awake video-assisted thoracic surgery, in the patient with advanced chronic obstructive pulmonary disease, emphysema, and hypoxaemia at rest (Drosos et al, 2020). Although awake tracheal reconstructions have also been reported in the literature, the use of the extracorporeal oxygenation support while awake has been limited only to the "suture sparing" strategy of tracheal reconstruction during the immediate postoperative period (Schieren et al, 2017).…”