Peripheral Cardiopulmonary Bypass under Local Anaesthesia for Tracheal Tumour Resection

Villanueva, Claudia; Milder, David; Manganas, Con

doi:10.1016/j.hlc.2015.01.021

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…The use of extracorporeal circuits to support pulmonary function during resection of a primary tracheal tumor was initially reported in 1961 but other reports with successful outcomes followed. 4 , 5 , 6 , 7 , 10 , 11 , 12 , 13 This technique provides a method of maintaining normal gas exchange allowing time for resection and good surgical access even if complete tracheal obstruction occurs. 11 , 14 CPB is well described as an adjunct to tracheal tumor resection but is rarely instituted under local anesthesia and mild intravenous sedation.…”

Section: Discussionmentioning

confidence: 99%

“…It is a challenge to anesthetize and even surgically resect these tumors when they occupy most of the tracheal lumen, especially when they are located lust above the carina, even without bronchial involvement 3 . Peripheral cardiopulmonary bypass (CPB) was instituted and described as a safe method to provide adequate oxygenation support during such surgeries 3–7 . In our case, a tracheal schwannoma was resected with the institution of peripheral femorofemoral venoarterial (VA) partial CPB in an awake patient under local anesthesia and mild intravenous sedation.…”

Section: Introductionmentioning

confidence: 99%

“…3 Peripheral cardiopulmonary bypass (CPB) was instituted and described as a safe method to provide adequate oxygenation support during such surgeries. [3][4][5][6][7] In our case, a tracheal schwannoma was resected with the institution of peripheral femorofemoral venoarterial (VA) partial CPB in an awake patient under local anesthesia and mild intravenous sedation. Harlequin, or North-South, syndrome (i.e., desaturation of the upper half of the body with well-saturated blood supplying the lower half) with its associated risks of myocardial and cerebral ischemia, along with other challenges were encountered and troubleshooted through multidisciplinary coordination between different teams.…”

Section: Introductionmentioning

confidence: 99%

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Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report

Karam

Nafeh

Aouad

et al. 2023

Clinical Case Reports

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Surgical resection of obstructive tracheal tumors can be challenging to cardiothoracic surgeons and anesthesiologists. It is often difficult in these cases to maintain oxygenation by face mask ventilation during induction of general anesthesia. Also, the extent and location of these tracheal tumors can preclude conventional induction of general anesthesia and subsequent successful endotracheal intubation. Peripheral cardiopulmonary bypass (CPB) under local anesthesia and mild intravenous sedation may be safe to support the patient until securing a definitive airway. We describe a case of a 19-year-old female with a tracheal schwannoma, who developed differential hypoxemia (Harlequin, or North-South, syndrome) after institution of awake peripheral femorofemoral venoarterial (VA) partial CBP. K E Y W O R D S differential hypoxemia, femorofemoral cardiopulmonary bypass (CPB), harlequin syndrome, north-south syndrome, venoarterial (VA) extracorporeal membrane oxygenation (ECMO), venovenous (VV) extracorporeal membrane oxygenation (ECMO) How to cite this article: Karam C, Nafeh NA, Aouad MT, et al. Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report

Karam

Nafeh

Aouad

et al. 2023

Clinical Case Reports

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The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review

Malpas

Hung

Gilchrist

et al. 2018

Can J Anesth/J Can Anesth

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While extracorporeal membrane oxygenation (ECMO) is an effective method of oxygenation for patients with respiratory failure, further refinement of its incorporation into airway guidelines is needed. We present a case of severe glottic stenosis from advanced thyroid carcinoma in which gas exchange was facilitated by veno-arterial ECMO prior to achieving a definitive airway. We also conducted a systematic review of the MEDLINE, EMBASE, CINAHL, and Web of Science databases, using the keywords "airway/ tracheal obstruction", "anesthesia", "extracorporeal", and "cardiopulmonary bypass" to identify reports where ECMO was initiated as the a priori method of oxygenation during difficult airway management.Thirty-six papers were retrieved discussing the use of ECMO or cardiopulmonary bypass (CPB) for the management of critical airway obstruction. Forty-five patients underwent pre-induction of anesthesia institution of CPB or ECMO for airway obstruction. The patients presenting with critical airway obstruction had a range of airway pathologies with tracheal tumours (31%), tracheal stenosis (20%), and head and neck cancers (20%) being the most common. All cases reported a favourable patient outcome with all patients surviving to hospital discharge without significant complications.While most practitioners are familiar with the fundamental airway techniques of bag-mask ventilation, supraglottic airway use, tracheal intubation, and front-of-neck airway access for oxygenation, these techniques have limitations in managing patients with pre-existing severe airway obstruction. The use of ECMO should be considered in patients with severe (or near-complete) airway obstruction secondary to anterior neck or tracheal disease. This approach can provide essential tissue oxygenation while attempts to secure a definitive airway are carried out in a controlled environment.

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Harlequin Syndrome during Peripheral Cardiopulmonary Bypass in a Patient with an Obstructing Tracheal Schwannoma: A Case Report

Karam

Nafeh

Aouad

et al. 2023

Preprint

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Peripheral Cardiopulmonary Bypass under Local Anaesthesia for Tracheal Tumour Resection

Cited by 4 publications

References 15 publications

Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report

Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report

The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review

Harlequin Syndrome during Peripheral Cardiopulmonary Bypass in a Patient with an Obstructing Tracheal Schwannoma: A Case Report

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