Use of ECMO in non-elective major thoracic surgery for infectious lung abscess

Objective Extracorporeal membrane oxygenation (ECMO) support for elective cardiothoracic surgery is well established. In contrast, there is not much data regarding the usefulness and outcome of ECMO in non- elective major lung resections for infectious lung abscess.

Methods All patients undergoing non-elective major lung surgery for infectious lung abscess at 5 university and tertiary referral hospitals in Germany, United Kingdom and Spain were enrolled in a prospective database. Malignant disorders and intrathoracic complications of other procedures were excluded.

Results There were 118 patients (88 male, 30 female). Median age was 59 years (Q1 49, Q3 67; IQR 18). Mean Charlson Index of comorbidity was 2.88 (SD 2.55). Surgical procedures were lobectomy (81), pneumectomy (19) and segmentectomy (18). Alcoholism (49), liver cirrhosis (12) and drug addiction (5) were common. Frequent preoperative septic complications were pulmonary sepsis (64), pleural empyema (63), persistent air leak (27) and respiratory failure (37). Mortality was 16/118. ECMO was used for 8 patients (pneumectomy 2, lobectomy 6) and several more received pre-ECMO treatment.

Intraoperatively no ECMO-associated complications were encountered. ECMO (1/7 v. 15/110; Odds ratio (OR): 0.90, 95% CI 0.10-7.88, p=0.93) as well as the extent of pulmonary resection were not associated with higher mortality. Preoperative sepsis (OR: 16.22, 95% CI 2.07-127.45, p<0.01), preoperative air leak (OR: 11.82, 95% CI 3.62-38.64, p<0.001), acute renal failure (OR: 5.52, 95% CI 1.65-18.41, p<0.01) and Charlson index of comorbidity≥3 (OR: 9.23, 95% CI 1.99-42.72, p<0.01) were associated with significantly higher mortality.

Conclusions The use of ECMO is widening the possibilities for successful surgical management of infectious, non- malignant lung abscess. Not only actual ECMO patients but also many more, who only undergo surgery because of the availability of ECMO at any time, benefit from an increased readiness to use ECMO.

Publikationsverlauf

Artikel online veröffentlicht:
17. Februar 2022