Extracorporeal life support and cardiopulmonary bypass for central airway surgery: A systematic review

Abstract

Background: Major airway surgery can pose a complex problem to perioperative central airway management. Adjuncts to advanced ventilation strategies have included cardiopulmonary bypass, veno-arterial, or veno-venous extracorporeal life support. We performed a systematic review to assess the existing evidence utilizing these strategies.Methods: An electronic search was conducted to identify studies written in English reporting the use of extracorporeal life support (ECLS) during central airway surgery. Thirty-six articles consisting of 78 patients were selected and patient-level data were analyzed.Results: Median patient age was 47 [IQR: 34-53] and 59.0% (46/78) were male. Indications for surgery included central airway or mediastinal cancer in 57.7% (45/78), lesion or injury in 15.4% (12/78), and stenosis in 12.8% (10/78).Support was initiated pre-operatively in 9.9% (7/71) and at the time of induction in 55.3% (42/76). It was most commonly used at the time of tracheal resection/repair [93.2% (68/73)], intubation of the tracheal stump [94.4% (68/72)], and re-anastomosis [94.2% (65/69)]; 13.7% (10/73) patients were supported postoperatively. The most commonly performed surgery was tracheal repair or resection in 70.3% (52/74). Median hospital stay was 12 [8, 25] days and in-hospital mortality was 7.9% (6/76). There was no significant difference in survival between the three groups (p = .54). Conclusions:Extracorporeal membrane oxygenation offers versatility in timing, surgical approach, and ECLS runtime that makes it a viable addition to the surgical armamentarium for treating complex central airway pathologies.

Extracorporeal life support in thoracic emergencies—a narrative review of current evidence

“…In distal airway ruptures, an endotracheal double lumen tube may prevent air leakage, tension pneumothorax or pneumomediastinum occluding the injured site. One-lung ventilation might be necessary but not sufficient for safe oxygenation (25,26). In such situations, a V-V ECLS can be used for respiratory support during surgery and post-operatively (24,(27)(28)(29)(30)(31).…”

The Systemic Immune-Inflammation Index Predicts In-Hospital Mortality in Patients Who Underwent On-Pump Cardiac Surgery

“…2 A CEC, por outro lado, é bem conhecida por iniciar uma cascata de reações inflamatórias, e essa resposta inflamatória tem sérias consequências clínicas. [2][3][4] Como resultado, investigar o papel das alterações inflamatórias no prognóstico do paciente tornou-se um alvo de alta prioridade para o desenvolvimento de estratégias terapêuticas e preventivas. 5 Para esse fim, muitos mediadores, como níveis de citocinas pró-inflamatórias, como IL-6, TNF, sistema de coagulação/fibrinolítico e marcadores de ativação do complemento foram investigados em relação à resposta inflamatória relacionada à CEC.…”