Extracorporeal membrane oxygenation assisted airway management during perioperative period of airway reconstruction
Objective To investigate the efficacy and safety of extracorporeal membrane oxygenation(ECMO)assisted airway management during perioperative period of airway reconstruction.Methods Ten patients were performed airway reconstruction using veno-venous(V-V)ECMO assisted airway management in Henan Provincial People's Hospital from July,2017 to July,2023,and their clinical data were retrospectively analyzed.Among 10 patients,8 had trauma complicated with tracheal/bronchial rupture,and the other 2 had tumors in the middle and lower tracheal segments.The NYHA classification was Ⅰ-Ⅱ before ECMO starting in all patients.The airway lesion location and Murray lung injury score in 8 patients,and the lumen obstruction in 2 patients were recorded.The application of ECMO,operative time,intraoperative maximal value of lactic acid,minimal value of blood oxygen saturation(SpO2),intraoperative ventilator pause time,tracheal catheter and ECMO withdrawal,total ECMO assisting time,postoperative mechanical ventilation time,postoperative ICU stay,total hospital stay and postoperative complication were recorded.Results(1)Among 8 patients with airway trauma,there were 1 case of middle and upper tracheal segment rupture,1 case of rupture at the opening of the left upper lobe,1 case of left main bronchus rupture,3 cases of right main bronchus rupture,and 2 cases of multiple segments and multiple tracheal injury;the Murray lung injury score was ≥3;7 patients were complicated with multiple site and multiple rib fractures;tracheal/bronchial rupture was clearly diagnosed in 6 cases before operation,and the other 2 patients with unclearly diagnosed lateral main bronchus rupture were suspected airway injury after a large number of bubbles were found in the closed thoracic drainage bottle with respiratory overflow;all 8 patients were treated with ECMO in ICU due to low SpO2 after tracheal intubation.The preoperative CT reconstruction showed＞50％obstruction in the middle and lower tracheal segments of 2 patients with tumors,and were treated with ECMO before operation.All 10 patients got normal SpO2 after ECMO application.(2)Mechanical ventilator was paused and replaced by ECMO intraoperatively in 7 patients,and 3 patients received mechanical ventilator combined with ECMO.The operative time was(234.3±73.2)min,the maximal value of lactic acid was(1.4±0.7)mmol/L,and the minimal value of Sp()2 was(89.3±4.9)％.The mechanical ventilator was paused for 67.5(0,127.5)min in 7 patients.(3)All 10 patients got successful operation and returned to ICU with tracheal catheter and ECMO after operation.The tracheal catheter and ECMO were successfully withdrawn and the patients were discharged alive.The total ECMO assisting time was(2.7±1.2)d,the postoperative mechanical ventilation time was(4.3±2.0)d,the length of postoperative ICU stay was(7.2±2.2)d,and the length of total hospital stay was(24.2±9.5)d.Postoperative pulmonary infection occurred in 3 cases,and left vocal cord paralysis occurred in 1 case.Conclusions The condition of airway reconstruction should be fully evaluated before operation.ECMO is safe and effective for patients who have difficulty in maintaining normal SpO2 after tracheal intubation or cannot endure tracheal intubation.
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