Major thoracic surgery during long-term extracorporeal lung assist for treatment of severe adult respiratory distress syndrome (ARDS)

Abstract

Surgery in patients treated with extracorporeal lung assist (ELA) carries a high risk of life threatening bleeding complications caused by the need for systemic anticoagulation. A case report describing a successful surgical intervention for the repair of a broncho-pleural leakage by thoracotomy during ELA is presented. A newly developed heparin coated extracorporeal system was used in a patient being treated for severe adult respiratory distress syndrome (ARDS) after left sided pneumectomy. The heparin coated system allowed discontinuation of systemic heparinization intraoperatively without coagulation complications related to the extracorporeal system. This procedure was followed by resolution of the ARDS.

Bronchial fistulae in ARDS patients: management with an extracorporeal lung assist device

“…So far, there have been several case reports of extracorporal membrane oxygenation for the successful management of bronchopleural fistulae [13][14][15]. Unlike pECLA treatment, pumpdriven extracorporal membrane oxygenation (vvECMO) offers considerable quantity of oxygen transfer along with carbon dioxide removal, but with substantial documented risk [16] and, therefore, should be limited to severely hypoxaemic patients.…”