1. Venovenous extracorporeal membrane oxygenation during high-risk airway interventions
- Author
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James Katsis, Whitney D. Gannon, John W. Stokes, Robert J. Lentz, Matthew Bacchetta, Clayne Benson, Fabien Maldonado, Sameer K Avasarala, Todd W. Rice, and Otis B. Rickman
- Subjects
Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Thoracic ,Deep vein ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Bronchoscopy ,Interquartile range ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Decompensation ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,medicine.disease ,Thrombosis ,Airway Obstruction ,surgical procedures, operative ,medicine.anatomical_structure ,030228 respiratory system ,Emergency medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Airway ,business - Abstract
OBJECTIVES Practice patterns for the use of extracorporeal membrane oxygenation (ECMO) during high-risk airway interventions vary, and data are limited. We aim to characterize our recent experience using ECMO for procedural support during whole-lung lavage (WLL) and high-risk bronchoscopy for central airway obstruction (CAO). METHODS We performed a retrospective cohort study of adults who received ECMO during WLL and high-risk bronchoscopy from 1 July 2018 to 30 March 2020. Our primary end point was successful completion of the intervention. Secondary end points included ECMO-associated complications and hospital survival. RESULTS Eight patients received venovenous ECMO for respiratory support during 9 interventions; 3 WLLs for pulmonary alveolar proteinosis were performed in 2 patients, and 6 patients underwent 6 bronchoscopic interventions for CAO. We initiated ECMO prior to the intervention in 8 cases and during the intervention in 1 case for respiratory decompensation. All 9 interventions were successfully completed. Median ECMO duration was 17.8 h (interquartile range, 15.9–26.6) for the pulmonary alveolar proteinosis group and 1.9 h (interquartile range, 1.4–8.1) for the CAO group. There was 1 cannula-associated deep vein thrombosis; there were no other ECMO complications. Seven patients (87.5%) and 4 (50.0%) patients survived to discharge and 1 year postintervention, respectively. CONCLUSIONS Use of venovenous ECMO to facilitate high-risk airway interventions is safe and feasible. Planned preprocedural ECMO initiation may prevent avoidable respiratory emergencies and extend therapeutic airway interventions to patients otherwise considered too high-risk to treat. Guidelines are needed to inform the utilization of ECMO during high-risk bronchoscopy and other airway interventions.
- Published
- 2021