Extracorporeal membrane oxygenation for management of iatrogenic distal tracheal tear

Hawkins, Robert B.; Thiele, Eryn L; Huffmyer, Julie L.; Bechtel, Allison J.; Yount, Kenan W.; Martin, Linda W.

doi:10.1016/j.xjtc.2020.07.020

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…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).…”

Section: Tracheobronchial Emergenciesmentioning

confidence: 99%

“…Moreover, in 0.8% of blunt thoracic trauma victims, tracheobronchial injuries occur ( 23 ). Although a conservative approach is advised where possible, there are some cases which require surgical intervention ( 24 ). In distal airway ruptures, an endotracheal double lumen tube may prevent air leakage, tension pneumothorax or pneumomediastinum occluding the injured site.…”

Section: Tracheobronchial Emergenciesmentioning

confidence: 99%

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

Willers¹,

Mariani²,

Maessen³

et al. 2023

J Thorac Dis

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Background and Objective: Resuscitative therapies for respiratory and cardiac failure are lifesaving and extended by using extracorporeal life support (ECLS) as mechanical circulatory support (MSC). This review informs the debate to identify the life-threatening thoracic emergencies in which patients may be cannulated for ECLS support.Methods: An advanced search was performed in PubMed, Embase, Google Scholar, and references query, assessed in June 2022, identified 761 records. Among them, 74 publications in English were included in the current narrative review.Key Content and Findings: ECLS is an additional tool for organ support in life-threatening thoracic emergencies. It provides bridging to recovery or to decision about destination as definitive therapy, intervention, or surgery. Non-traumatic emergencies include mediastinal mass, acute lung injury (ALI), aspiration, embolisms, acute and chronic heart failure. However, based on the current evidence, trauma, and especially blunt thoracic trauma, is one of the main indications for ECLS use in thoracic emergencies, among others in chest wall fractures, blunt and penetrating lung injuries. ECLS use is always individualized to patient's needs, injury pattern and kind of organ failure, circulatory arrest inclusive, depending on if respiratory or cardiac and circulatory support is needed. Further, ECLS offers the possibility for fast volume resuscitation and rewarming, thus preventing the lethal of trauma: hypothermia, hypoperfusion and acidosis. Anticoagulation may be omitted for some hours or days. Interdisciplinary cooperation between the intensivists, surgeons, anesthesiologists, emergency medical services, an appropriately organized and trained staff, equipment resources and logistical planning are essential for successful outcomes.Conclusions: ECLS use in selected life-threatening thoracic emergencies is increasing. The summarized findings appeal to policymakers, and we hope that our summary of recommendations may impact clinical practice and research.

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Section: Tracheobronchial Emergenciesmentioning

confidence: 99%

Section: Tracheobronchial Emergenciesmentioning

confidence: 99%

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

Willers¹,

Mariani²,

Maessen³

et al. 2023

J Thorac Dis

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“…Although a conservative approach is advised where possible, there are some cases which require surgical intervention, especially where life threatening respiratory compromise occurs (34). In these instances, VV-ECMO has been utilised to provide both pre-operative stabilisation as well as peri and post-operative ventilatory support (35)(36)(37). VV-ECMO has also been used to support repair of tracheoesophageal fistula secondary to chemoradiation (38) and oesophagectomy (39).…”

Section: Tracheobronchial Surgerymentioning

confidence: 99%

The role of extracorporeal membrane oxygenation in thoracic surgery—a narrative review

Eadington¹,

Oommen²

2022

Shanghai Chest

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Background and Objective: Thoracic surgical patients provide unique challenges which can make maintaining adequate ventilation difficult or impossible. Despite advances in anaesthetic technique there are situations where other methods must be employed. The aim of this review is to provide an overview of extracorporeal membrane oxygenation (ECMO) and how it can be utilised in thoracic surgical patients.Methods: Library searches of PubMed ® and EMBASE databases were carried out to identify literature for inclusion in this review. Timeframe for consideration was from origin to 5/1/22. No restrictions were made on the basis of language.Key Content and Findings: ECMO has traditionally been used in emergency settings to manage severe respiratory or haemodynamic failure refractory to conventional medical therapy. In recent years there has been an expansion in the use of this technology beyond these settings, and it is increasingly being used in a range of emergency and elective thoracic surgical patients. The configuration of the ECMO circuit, and it's duration of use are determined by the clinical need. The use of ECMO is associated with significant complications therefore its use requires careful consideration by an experienced multidisciplinary team.Complications can be related to the underlying pathology and patient related factors, or due to circuit related factors and the duration of use. Conclusions:The use of ECMO in thoracic surgery is rare and thus the evidence base is limited. As its use in thoracic surgical patients continues to increase, there is clear need for randomised trials to demonstrate the benefit of this technology in this complex group of patients.

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“…In this issue of JTCVS Techniques , Hawkins and colleagues 1 present a challenging case of iatrogenic tracheal injury after multiple intubation attempts. The patient had presented with respiratory compromise due to viral pneumonia, and the resultant loss of tidal volume due to the tracheal injury precipitated profound respiratory failure and acidosis.…”

mentioning

confidence: 99%

Commentary: Building bridges with extracorporeal membrane oxygenation

Hanna

2020

JTCVS Techniques

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Extracorporeal membrane oxygenation for management of iatrogenic distal tracheal tear

Cited by 6 publications

References 8 publications

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

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

The role of extracorporeal membrane oxygenation in thoracic surgery—a narrative review

Commentary: Building bridges with extracorporeal membrane oxygenation

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