Extracorporeal life support and cardiopulmonary bypass for central airway surgery: A systematic review.

Autor: O'Malley TJ; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Yost CC; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Prochno KW; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Saxena A; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Grenda TR; Division of Thoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Evans NR; Division of Thoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Cowan SW; Division of Thoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Morris RJ; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Massey HT; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Tchantchaleishvili V; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Artificial organs [Artif Organs] 2022 Mar; Vol. 46 (3), pp. 362-374. Date of Electronic Publication: 2021 Nov 16.
DOI: 10.1111/aor.14084
Abstrakt: Background: Major airway surgery can pose a complex problem to perioperative central airway management. Adjuncts to advanced ventilation strategies have included cardiopulmonary bypass, veno-arterial, or veno-venous extracorporeal life support. We performed a systematic review to assess the existing evidence utilizing these strategies.
Methods: An electronic search was conducted to identify studies written in English reporting the use of extracorporeal life support (ECLS) during central airway surgery. Thirty-six articles consisting of 78 patients were selected and patient-level data were analyzed.
Results: Median patient age was 47 [IQR: 34-53] and 59.0% (46/78) were male. Indications for surgery included central airway or mediastinal cancer in 57.7% (45/78), lesion or injury in 15.4% (12/78), and stenosis in 12.8% (10/78). Support was initiated pre-operatively in 9.9% (7/71) and at the time of induction in 55.3% (42/76). It was most commonly used at the time of tracheal resection/repair [93.2% (68/73)], intubation of the tracheal stump [94.4% (68/72)], and re-anastomosis [94.2% (65/69)]; 13.7% (10/73) patients were supported post-operatively. The most commonly performed surgery was tracheal repair or resection in 70.3% (52/74). Median hospital stay was 12 [8, 25] days and in-hospital mortality was 7.9% (6/76). There was no significant difference in survival between the three groups (p = .54).
Conclusions: Extracorporeal membrane oxygenation offers versatility in timing, surgical approach, and ECLS runtime that makes it a viable addition to the surgical armamentarium for treating complex central airway pathologies.
(© 2021 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.)
Databáze: MEDLINE
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