Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome.

Autor:	Karampinis I; Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK.; Academic Thoracic Center, University Medical Center Mainz, Johannes Gutenberg University Mainz, Germany., Al-Shammari A; Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK., Hartley P; Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK., Patel M; Division of Critical Care, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK., Arachchillage DRJ; Division of Hematology, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK.; Centre for Hematology, Imperial College London, London, UK., Jordan S; Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK., Thakuria L; Division of Critical Care, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK., Garfield B; Division of Critical Care, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK., Ledot S; Division of Critical Care, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK., Buderi S; Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Jazyk:	angličtina
Zdroj:	Perfusion [Perfusion] 2023 May; Vol. 38 (4), pp. 837-842. Date of Electronic Publication: 2022 May 05.
DOI:	10.1177/02676591221090618
Abstrakt:	Objectives: The COVID-19 pandemic has generated a new type of acute respiratory distress syndrome (ARDS) arising as a complication of COVID-19 pneumonia. Extreme cases require the support of extracorporeal membrane oxygenation (ECMO). Here we present the outcomes of patients that underwent surgical tracheostomy or thoracic surgery at a single tertiary centre whilst on ECMO support for COVID-19 related ARDS. Methods: 18 patients requiring thoracic input whilst on ECMO support during the first wave of COVID-19 (March-June 2020) were included. Thoracic surgery was required both for performing surgical tracheostomies in the operating theatre and for treating emergencies arising under the ECMO treatment such as bleeding complications. Results: Thirteen patients underwent a surgical tracheostomy, whilst five patients had an invasive thoracic procedure. Anticoagulation was withheld for at least 12 h in the perioperative setting regardless of the indication. One patient was re-operated for haemothorax immediately after the end of the primary operation. 94.5% of the patients were successfully decannulated from ECMO support. Overall 30-day mortality in the cohort was 5.5% (1/18). Conclusions: Thoracic surgeons can play a valuable role in supporting an ECMO unit during the COVID pandemic, by treating ECMO related complications and by safely performing surgical tracheostomies. Withholding anticoagulation in the perioperative window was not associated with increased thromboembolic events and is desirable when interventions or surgery is indicated in this patient cohort to avoid excessive bleeding.
Databáze:	MEDLINE
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