title: National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation (ECMO) for respiratory support is increasingly used in intensive care units (ICU), but rarely during thoracic surgical procedures outside the transplantation setting. ECMO can be an alternative to cardiopulmonary bypass for major trachea-bronchial surgery and single-lung procedures without in-field ventilation. Our aim was to evaluate the intraoperative use of ECMO as respiratory support in thoracic surgery: benefits, indications and complications.
  
  
  METHODS
  This was a multicentre retrospective study (questionnaire) of use of ECMO as respiratory support during the thoracic surgical procedure. Lung transplantation and lung resection for tumour invading the great vessels and/or the left atrium were excluded, because they concern respiratory and circulatory support.
  
  
  RESULTS
  From March 2009 to September 2012, 17 of the 34 centres in France applied ECMO within veno-venous (VV) (n=20) or veno-arterial (VA) (n=16) indications in 36 patients. Ten VA ECMO were performed with peripheral cannulation and 6 with central cannulation; all VV ECMO were achieved through peripheral cannulation. Group 1 (total respiratory support) was composed of 28 patients without mechanical ventilation, involving 23 tracheo-bronchial and 5 single-lung procedures. Group 2 (partial respiratory support) was made up of 5 patients with respiratory insufficiency. Group 3 was made up of 3 patients who underwent thoracic surgery in a setting of acute respiratory distress syndrome (ARDS) with preoperative ECMO. Mortality at 30 days in Groups 1, 2 and 3 was 7, 40 and 67%, respectively (P<0.05). In Group 1, ECMO was weaned intraoperatively or within 24 h in 75% of patients. In Group 2, ECMO was weaned in ICU over several days. In Group 1, 2 patients with VA support were converted to VV support for chronic respiratory indications. Bleeding was the major complication with 17% of patients requiring return to theatre for haemostasis. There were two cannulation-related complications (6%).
  
  
  CONCLUSIONS
  VV or VA ECMO is a satisfactory alternative to in-field ventilation in complex tracheo-bronchial surgery or in single-lung surgery. ECMO should be considered and used in precarious postoperative respiratory conditions. Full respiratory support can be achieved with VV ECMO. Indications for and results of ECMO during surgery in patients with ARDS warrant further careful investigation.
authors.affiliation: Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France philippe.rinieri@chu-rouen.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rinieri
authors.affiliation: Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Peillon
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Bessou
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care, Rouen University Hospital, Rouen, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Veber
authors.affiliation: Department of General and Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Melki
authors.affiliation: Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Baste
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D012128:Respiratory Distress Syndrome; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality
keywords: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Mechanical ventilation; Thoracic surgery; Trachea