Perioperative Anesthetic and Transfusion Management of Veno-Venous Extracorporeal Membrane Oxygenation Patients Undergoing Noncardiac Surgery: A Case Series of 21 Procedures

Establishing Best Practices for Patients on ECMO—A Multidisciplinary Challenge

“…Extracorporeal membrane oxygenation has shown itself to be a tour de force in the clinical realm, not only saving lives, but also affecting virtually every medical service in the hospital in the process. In their article "Perioperative Anesthetic and Transfusion Management of Veno-Venous Extracorporeal Membrane Oxygenation Patients Undergoing Noncardiac Surgery: A Case Series of 21 Procedures," 2 Fierro and colleagues not only shed light on intraoperative management strategies for ECMO patients undergoing noncardiac surgery, but also in the process expose the vast impact ECMO patients have on the hospital system in general.…”

“…In their review, Fierro and colleagues note that 14 patients underwent a total of 21 noncardiac procedures while on venovenous ECMO. 2 A review of the authors' own data of patients on venovenous ECMO at the University of Pennsylvania demonstrates a range of surgical procedures have been performed in this patient population, ranging from tracheostomy to intra-abdominal procedures to cannula site exploration for bleeding.…”

“…Fierro's paper nicely illustrates this lack of consensus, with a fairly large discrepancy in the fundamental anesthetic type that was used (71% of patients received an inhalational anesthetic). 2 At the University of Pennsylvania, the use of intravenous anesthesia is more common than volatile anesthetics in this situation. There are gaps in understanding of drug pharmacokinetics in the presence of an ECMO circuit, 7 making the ideal anesthetic while on ECMO uncertain.…”