Outcome Of Extracorporeal Membrane Oxygenation Support During Surgery For The Trachea And Upper Airway Obstruction
Sanjay Kumar, MCh,FRCS1, Vladamir Shumaster, MD2.
1Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, 2Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA.
BACKGROUND: Anesthetic management of airways during operation of critical airway stenosis is often very challenging. Extracorporeal membrane oxygenation (ECMO) may provide adequate respiratory support when conventional approaches for airway management fail or not feasible while operating on critical airway stenosis. METHODS:In this retrospective study from our database we report our experience of ECMO support for critical airway surgery. Twelve patients underwent ECMO-supported airway operation between January 2014 and December 2021, RESULTS: The indications for surgery was tracheal stenosis in 9 patients, and tracheomalacia, tracheal tumor, and external tracheal compression by mediastinal mass in one patient each. Resection and end-to-end anastomosis was performed in seven patients; the remainder underwent diverse procedures, including tracheoplasty, tracheal ballooning, tracheostomy, and debulking of mediastinal mass. Extracorporeal membrane oxygenation support was sufficient for gas exchange during surgery and 9 patients were successfully weaned off intraoperatively. The median time on ECMO was 2.54 hours (range: 1.2-208 hours). There was no ECMO-related complication recorded. The median intensive care unit stay, median hospital stay, and mean follow-up period were 2 days (range: 1-46 days), 37 days (range: 7-292 days), and 17.1 ± 10.8 months, respectively. The rate of freedom from reintervention was 75.2%; the mean survival rates over 1 and 2 years were 83% and 67%, respectively. CONCLUSIONS: This retrospective study indicates that ECMO is a feasible and safe method for oxygenation as an alternative to airway management during critical airway surgery.
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