The Annals of thoracic surgery · 2010
Thoracic surgical procedures supported by a pumpless interventional lung assist.
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Wiebe Karsten, Poeling Jochen, Arlt Matthias, Philipp Alois, Camboni Daniele, Hofmann Stefan, Schmid Christof
Аннотация
BACKGROUND: For support of pulmonary function during complex thoracic surgical procedures, especially in respiratory compromised patients, a pumpless interventional lung assist (iLA) was applied. Feasibility and effectiveness for this novel indication were evaluated.
METHODS: Ten patients underwent thoracic surgery with respiratory support by iLA. Indication for iLA application was the need for intraoperative prolonged discontinuation of ventilation (tracheal surgery and lung resections after pneumonectomy [n = 6], and emergency procedures in patients with acute respiratory failure [n = 4]. The pumpless extracorporeal system was inserted percutaneously into the femoral blood vessels before surgery. Blood flow through the iLA, cardiac output, and gas exchange were monitored.
RESULTS: In all patients, the surgical procedure was successfully performed because of the support by the pumpless iLA. Mean blood flow across the iLA was 1.58 +/- 0.3 L/min (1.2 L/min to 2.2 L/min). Low-dose norepinephrine was required to maintain sufficient systemic blood pressure. There was a moderate improvement in oxygenation (49 mL/min transfer of O(2)) and a very efficient elimination of carbon dioxide (121 mL/min transfer of CO(2)). Thus, extended periods of apneic oxygenation were possible during surgery. The device was removed immediately after surgery in 6 patients. In 4 patients with severe respiratory insufficiency, the iLA was continued for a mean of 6.8 days to allow for protective postoperative ventilation.
CONCLUSIONS: The application of pumpless iLA was hemodynamically well tolerated, and allowed for safe procedures in respiratory compromised patients, avoiding the application and consequences of cardiopulmonary bypass or pump-driven extracorporeal membrane oxygenation.
METHODS: Ten patients underwent thoracic surgery with respiratory support by iLA. Indication for iLA application was the need for intraoperative prolonged discontinuation of ventilation (tracheal surgery and lung resections after pneumonectomy [n = 6], and emergency procedures in patients with acute respiratory failure [n = 4]. The pumpless extracorporeal system was inserted percutaneously into the femoral blood vessels before surgery. Blood flow through the iLA, cardiac output, and gas exchange were monitored.
RESULTS: In all patients, the surgical procedure was successfully performed because of the support by the pumpless iLA. Mean blood flow across the iLA was 1.58 +/- 0.3 L/min (1.2 L/min to 2.2 L/min). Low-dose norepinephrine was required to maintain sufficient systemic blood pressure. There was a moderate improvement in oxygenation (49 mL/min transfer of O(2)) and a very efficient elimination of carbon dioxide (121 mL/min transfer of CO(2)). Thus, extended periods of apneic oxygenation were possible during surgery. The device was removed immediately after surgery in 6 patients. In 4 patients with severe respiratory insufficiency, the iLA was continued for a mean of 6.8 days to allow for protective postoperative ventilation.
CONCLUSIONS: The application of pumpless iLA was hemodynamically well tolerated, and allowed for safe procedures in respiratory compromised patients, avoiding the application and consequences of cardiopulmonary bypass or pump-driven extracorporeal membrane oxygenation.