Rescue extracorporeal membrane oxygenation for massive anterior mediastinal masses

Leow, Lowell; Sampath, Hari Kumar; Yong, Keith; Kofidis, Theo; Tam, John Kit Chung; MacLaren, Graeme; Teo, Lynette Ls; Mithiran, Harish; Ramanathan, Kollengode

doi:10.1007/s10047-021-01264-6

Cited by 16 publications

(11 citation statements)

References 19 publications

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“…Timely transferal to a tertiary referral center with experience in cardiothoracic surgery and mechanical circulatory support is key in preventing catastrophic cardiorespiratory decompensation. Our case also demonstrated that ECMO can be successfully used in pediatric patients with massive mediastinal mass as a cardiovascular support modality during surgical treatment, for which there is only a limited number of pediatric case reports (26,27). Multi-disciplinary input is essential to facilitate tumor resection and to minimize morbidity and mortality.…”

Section: Discussionmentioning

confidence: 77%

Case Report: Primary Thoracic Low-Grade Fibromyxoid Sarcoma in a Young Girl Presenting With Mediastinal Mass Syndrome

Chan

Kan²,

Yuen³

et al. 2022

Front. Pediatr.

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Section: Discussionmentioning

confidence: 77%

Case Report: Primary Thoracic Low-Grade Fibromyxoid Sarcoma in a Young Girl Presenting With Mediastinal Mass Syndrome

Chan

Kan²,

Yuen³

et al. 2022

Front. Pediatr.

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“…Table 1 summarizes the cases of ECMO in patients with hematological malignancies of the anterior mediastinal [5][6][7][8][9][10][11][12][13][14][15], including the present case, focusing on the intensive care period, airway management, and complications. The stenosis site extended from the lower part of the trachea to the bifurcation or the main bronchus in all cases, suggesting that ECMO introduction might be needed when respiratory management is difficult.…”

Section: Discussionmentioning

confidence: 99%

“…An ECMO might be useful as a bridge to chemotherapy in patients with airway emergencies to increase the survival rate for such patients [ 4 ]; however, remission-induction chemotherapy causes neutropenia and an immunocompromised state, placing patients at risk of severe infections, such as ventilator-associated pneumonia. In such situations, ES may shorten the intensive care period [ 5 ]. Hence, planned ECMO and ES can be appropriate for respiratory management of these cases.…”

Section: Discussionmentioning

confidence: 99%

Airway Emergencies Due to Anterior Mediastinal T-Lymphoblastic Lymphoma Managed With Planned Extracorporeal Membrane Oxygenation and Endotracheal Stent: A Case Report and Literature Review

Oyake¹,

Suenobu²,

Miyawaki³

et al. 2022

Cureus

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Anterior mediastinal tumors can occasionally cause acute respiratory failure by compressing the trachea and bronchi. In such cases, sedative muscle relaxants during tracheal intubation can cause fatal complete tracheal obstruction. We encountered a 15-year-old male patient with T-lymphoblastic lymphoma (T-LBL) of the anterior mediastinum. For his airway emergency due to the stenosis extended from the lower part of the trachea to the tracheal bifurcation, venovenous (VV) extracorporeal membrane oxygenation (ECMO) was introduced from the femoral vein under local anesthesia. After a short period of tracheal intubation management, an endotracheal stent (ES) was immediately placed in the lower trachea. We performed a needle biopsy, and he was diagnosed with T-LBL. Following the diagnosis, chemotherapy was introduced.The ES was able to secure sufficient tracheal diameter, and ECMO and ventilation were promptly discontinued. In the case of tracheal stenosis from the lower part of the trachea due to anterior mediastinal tumor, depending on the degree of stenosis, VV ECMO can be considered. Moreover, ES can lead to early weaning from VV ECMO and a ventilator.

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“…Surgical conditions and anaesthesia can exacerbate this, further reducing cardiac output. Both VV and VA-ECMO have been utilised to provide perioperative support during resection of large mediastinal tumours (57). VA-ECMO may be preferred due to the additional haemodynamic support it offers.…”

Section: Mediastinal Pathologymentioning

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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Rescue extracorporeal membrane oxygenation for massive anterior mediastinal masses

Cited by 16 publications

References 19 publications

Case Report: Primary Thoracic Low-Grade Fibromyxoid Sarcoma in a Young Girl Presenting With Mediastinal Mass Syndrome

Case Report: Primary Thoracic Low-Grade Fibromyxoid Sarcoma in a Young Girl Presenting With Mediastinal Mass Syndrome

Airway Emergencies Due to Anterior Mediastinal T-Lymphoblastic Lymphoma Managed With Planned Extracorporeal Membrane Oxygenation and Endotracheal Stent: A Case Report and Literature Review

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

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