Intraoperative extracorporeal life support in tracheal surgery:a single-center experience

Wang Yifeng; Sun Lin; Zhou Xiaoyu; Chang Xin; Xu Lingfeng; Guo Zhen

doi:10.13498/j.cnki.chin.j.ecc.2024.01.06

Abstract：Objective To evaluate the safety and superiority of extracorporeal life support(ECLS)in critical tracheal surgery.Methods As a single-center retrospective study,the data of patients undergoing high-risk tracheal surgery supported with extracorporeal membrane oxygenation(ECMO)or cardiopulmonary bypass(CPB)from January 2000 to December 2020 were collected.Baseline characteristics,hospitalization complications,ECLS management,surgery-related data,and mortality were evaluated.Results A total of 107 patients received ECMO or CPB support during the study period,including 67 males(62.6%)with a median age of 48.9 years(range,14-76 years).Surgical procedures involved the trachea tumour(67 cases),tracheal stenosis(23 cases),tracheal compression(9 cases),and tracheal fistulas(8 cases).Classic CPB(n = 28,26.2%),modified CPB(n = 19,17.8%),and veno-venous ECMO(VV-ECMO,n = 44,41.1%)or veno-arterial ECMO(VA-ECMO,n = 16,15.0%)were used during twenty years.ECMO and modified CPB groups used heparin-free(n = 18,16.8%)or low-dose heparin(n = 61,57.0%).The median pump duration of CPB,modified CPB,VV and VA ECMO was 49,67,144 and 118 minutes,respectively.Intraoperative complications(massive hemorrhage,hypoxia and unstable circulation)occurred in 8 patients(7.5%),and postoperative complications(anastomotic leakage,atelectasis,respiratory tract infection and bronchopleural fistula)occurred in 23 patients(21.5%).More patients in CPB group(14/28)received blood transfusion,but there was no significant difference in blood transfusion volume compared with other groups.The perioperative mortality rate was 6.5%(n = 7).Conclusion Despite intraoperative cardiopulmonary support being rarely used in tracheal and carinal disease,the critical tracheal disease can be successfully treated with CPB or ECMO.ECMO provides safe and effective gas exchange to ensure a safe and smooth procedure and it is the most commonly used technology during surgery in recent years.