The Safety of Brief ECMO Support in Difficult Central Airway Interventions

Abstract

PURPOSE: Complex central airway disorders can be life-threatening and present unique challenges in maintaining ventilation and oxygenation during interventional bronchoscopy. ExtraCorporeal Membrane Oxygenation (ECMO) offers the interventional bronchoscopist an opportunity to methodically approach each intervention while alleviating the temporary loss of ventilation that often occurs. Also, concern for airway FIO2 during protracted laser procedures can be mitigated. METHODS: We present 6 cases of ECMO support in 5 patients undergoing difficult central airway interventions. Four of 5 patients had severe malignant airway obstructions caused by either tumor or severe extrinsic compression and one patient suffered total dehiscence of the bronchial stump after pneumonectomy requiring occlusive stenting. Each patient had life-threatening airway compromise.that required urgent intervention, including balloon bronchoplasty, stenting or laser photoresection of tumor. In each case, rigid bronchoscopy was utilized. Two (2) men and three (3) women, ages 34 - 65, underwent various types of ECMO support to provide oxygenation while allowing for complex airway interventions. ECMO support allowed prolonged periods of total apnea. The first patient underwent Veno-arterial ECMO and the other five procedures were performed with Veno-venous support. All patients underwent ECMO initiated in the operative suite prior to rigid bronchoscopy RESULTS: ECMO support ranged from 82 to 179 minutes, with an average of 112 minutes. All were weaned from ECMO support at the conclusion of each procedure and none suffered serious hypoxic or hemodynamic sequelae. Three patients were extubated in the operating room at the end of the procedure, 2 were extubated the following day and one was extubated 48 hours after the intervention. One patient underwent ECMO supported rigid bronchoscopy twice for severe extrinsic compression. . All patients have done well with follow-up ranging from one month to one year. CONCLUSIONS: Planned peri-operative ECMO confers a significant margin of patient safety allowing the interventionalist to focus on operative tasks during periods of complete apnea without concern for loss of oxygenation and ventilation and oxygenation. Close communication with the anesthesiology and ECMO teams is of paramount importance.