Veno-right ventricular extracorporeal membrane oxygenation for thoracic surgery: an experimental study in dogs.
BACKGROUND
Although the indications for extracorporeal membrane oxygenation (ECMO) have been extended, ECMO has yet to be used as a respiratory support system during thoracic surgery. The purpose of this experimental study was to investigate whether veno-right ventricular (veno-RV) ECMO can be used for thoracic surgery without mechanical ventilation.


METHODS
Acute experimental study: Veno-RV ECMO as total lung support was maintained for 60 min without mechanical ventilation in six dogs. A venous drainage cannula was inserted in the superior cavoatrial junction through the right femoral vein and a venous return cannula was inserted in the right ventricle through the right jugular vein. The veno-RV ECMO system comprised a centrifugal pump and membrane oxygenator. Survival model: After veno-RV ECMO had been established in three dogs, a two-ring thoracic tracheal segment was resected and the tracheal ends were anastomosed by video-assisted thoracic surgery without ventilation.


RESULTS
In the acute study, when the veno-RV ECMO flow was maintained at 100 mL/kg/min, all six dogs remained hemodynamically stable and the arterial oxygen saturation was maintained at more than 98%, despite total lung collapse. In the survival study, all three dogs made an uneventful postoperative recovery.


CONCLUSIONS
Video-assisted tracheal surgery can be performed without conventional respiratory support. Veno-RV ECMO as total lung support may become an alternative respiratory management device for thoracic surgery.
Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Nabeshima, Japan.
K
K
Horita
Z L
ZL
Cao
T
T
Itoh
D000714:Anastomosis, Surgical; D000818:Animals; D002404:Catheterization / Q000295:instrumentation; D004195:Disease Models, Animal; D004285:Dogs; D004322:Drainage / Q000295:instrumentation; D004724:Endoscopy; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D005268:Femoral Vein; D006325:Heart Atria; D006352:Heart Ventricles; D006439:Hemodynamics; D007601:Jugular Veins; D010100:Oxygen / Q000097:blood; D010107:Oxygenators, Membrane; D012121:Respiration, Artificial; D015996:Survival Rate; D019616:Thoracic Surgical Procedures; D013906:Thoracoscopy; D013908:Thoracotomy; D014132:Trachea / Q000601:surgery; D014683:Vena Cava, Superior; D014741:Video Recording
D010100:Oxygen