Otherwise, inoperable. The role of ECMO in thoracic surgery – focus on the mediastinum
DOI:
https://doi.org/10.48729/pjctvs.540Keywords:
ECMO, mediastinal mass syndrome, inoperable, Mediastinal tumorAbstract
The use of extracorporeal membrane oxygenation (ECMO) in surgery is expanding as the medical community started adopting it, with good results, for procedures with high risk of respiratory and hemodynamic instability. This technique provided the possibility to reduce the number of patients previously considered inoperable because of these limitations.
Thymic epithelial tumors (TETs) are rare neoplastic mediastinal lesions, with a reported incidence of 0.3 per million. They are indolent and associated with a delayed diagnosis, as symptoms arise late. Some can reach such dimensions that surgery without ECMO support would render these patients at risk of heart/great vessels or/and respiratory compression of prohibitive surgical risk or even inoperable.
This report aims to update information on ECMO support in surgery for prevascular mediastinal masses, focusing on pre-operatory assessment, ECMO implantation, patient selection and surgical results.
Downloads
References
Suzuki Y, Cass S, Lentz Carvalho J, DeAnda A, Radhakrishnan RS. Extracorporeal Membrane Oxygenation for Patients With Thoracic Neoplasms: An Extracorporeal Life Support Organization (ELSO) Registry Analysis. Ann Thorac Surg. 2022 Nov;114(5):1816-1822. doi: 10.1016/j.athoracsur.2022.03.030. Epub 2022 Mar 26. PMID: 35351418.
Duwe BV, Sternam DH, Musani AI. Tumors of the mediastinum. Chest 2005; 128(4): 2893-909.
Kashima J, Okuma Y, Murata H, Watanabe K, Hosomi Y, Hishima T. Chemoradiotherapy for unresectable cases of thymic epithelial tumors: a retrospective study. J Thorac Dis. 2017 Oct;9(10):3911-3918. doi: 10.21037/jtd.2017.08.133.
Erdo G, Tzanova I. Perioperative anesthetic management of mediastinal mass in adults. Eur J Anaesthesiol 2009;26:627–632.
Béchard P, Létourneau L, Lacasse Y, et al. Perioperative cardiorespiratory complications in adults with mediastinal mass: incidence and risk factors. Anesthesiology 2004;100:826-34; discussion 5A. doi: 10.1097/00000542-200404000-00012.
Blank RS, de Souza DG. Anesthetic management of patients with an anterior mediastinal mass: continuing professional development. Can J Anaesth 2011;58:853–859, 860–867.
Rath L, Gullahorn G, Connolly N, Pratt T, Boswell G, Cornelissen C. Anterior mediastinal mass biopsy and resection: anesthetic techniques and perioperative concerns. Semin Cardiothorac Vasc Anesth 2012;16:235–242.
Lee J, Rim YC, In J. An anterior mediastinal mass: delayed airway compression and using a double lumen tube for airway patency. J Thorac Dis 2014;6:E99–E103.
Vanneman MW, Fikry K, Quraishi SA, Schoenfeld W. A Young Man with a Mediastinal Mass and Sudden Cardiac Arrest. Ann Am Thorac Soc. 2015 Aug;12(8):1235-9. doi: 10.1513/AnnalsATS.201504-212CC.
Takeda S, Miyoshi S, Omori K, Okumura M, Matsuda H. Surgical rescue for life-threatening hypoxemia caused by a mediastinal tumor. Ann Thorac Surg. 1999 Dec;68(6):2324-6. doi: 10.1016/s0003-4975(99)01116-9. PMID: 10617025.
Yu J, Liu B, Zhou R. Extracorporeal membrane oxygenation (ECMO) assisted huge mediastinal tumor resection combined with superior vena cava replacement: A case report and literature review. Perfusion. 2024 Apr 29:2676591241251443. doi: 10.1177/02676591241251443.
Zhang S, Tan D, Wu W, et al. Extracorporeal membrane oxygenation (ECMO) assisted mediastinal tumor resection and superior vena cava replacement are safe and feasible. Thorac Cancer. 2019 Sep;10(9):1846-1851. doi: 10.1111/1759-7714.13140.
Ramanathan K, Leow L, Mithiran H. ECMO and adult mediastinal masses. Indian J Thorac Cardiovasc Surg. 2021 Apr;37(Suppl 2):338-343. doi: 10.1007/s12055-020-01077-x.
Shao Y, Shen M, Ding Z, Liang Y, Zhang S. Extracorporeal membrane oxygenation-assisted resection of goiter causing severe extrinsic airway compression. Ann Thorac Surg. 2009;88:659–6.
Nokes BT, Vaszar L, Jahanyar J, Swanson KL. VV-ECMO-assisted high-risk endobronchial stenting as rescue for asphyxiating mediastinal mass. J Bronchology Interv Pulmonol. 2018;25:144–7.
Booka E, Kitano M, Nakano Y, et al. Life-threatening giant esophageal neurofibroma with severe tracheal stenosis: a case report. Surg Case Rep. 2018;4:107.
Suzuki Y, Mao RD, Shah NR, et al. Prevalence and Impact of Infection during Extracorporeal Membrane Oxygenation in Oncologic Patients: A Retrospective Analysis of the Extracorporeal Life Support Organization (ELSO) Registry. J Intensive Care Med 2022. doi: 10.1177/08850666221128243.
Schmidt M, Schellongowski P, Patroniti N, et al. Six-month outcome of immunocompromised patients with severe acute respiratory distress syndrome rescued by extracorporeal membrane oxygenation. Am J Respir Crit Care Med. 2018;197:1297–307.
Schmidt M, Combes A, Shekar K. ECMO for immunosuppressed patients with acute respiratory distress syndrome: drawing a line in the sand. Intensive Care Med. 2019;45:1140–2.
Ramanathan K, Cove ME, Caleb MG, Teoh KL, Maclaren G. Ethical dilemmas of adult ECMO: emerging conceptual challenges. J Cardiothorac Vasc Anesth. 2015;29:229–33.
Downloads
Published
How to Cite
License
Copyright (c) 2024 Portuguese Journal of Cardiac Thoracic and Vascular Surgery
This work is licensed under a Creative Commons Attribution 4.0 International License.
