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Zentralbl Chir 2019; 144(01): 71-77
DOI: 10.1055/a-0655-2326
Übersicht – Thoraxchirurgie
Georg Thieme Verlag KG Stuttgart · New York

ECMO in der Thoraxchirurgie: Grundlagen und Pathophysiologie

Extracorporeal Lung Support in Thoracic Surgery: Basics and Pathophysiology
Bassam Redwan
1   Sektion für Thoraxchirurgie, Universitätsklinik Münster, Deutschland
,
Ali Akil
2   Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Deutschland
,
Stefan Freermann
2   Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Deutschland
,
Stefan Fischer
2   Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Deutschland
› Author Affiliations
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Publication History

Publication Date:
04 September 2018 (online)

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Zusammenfassung

Die extrakorporale Lungenunterstützung (ECLS) stellt heutzutage ein gut etabliertes Verfahren in der Thoraxchirurgie dar. In Abhängigkeit von der respiratorischen und hämodynamischen Situation des Patienten wird die ECLS in verschiedenen Modalitäten eingesetzt. Dies erfordert ein ausreichendes Wissen über die verschiedene ECMO-Modalitäten (ECMO: extrakorporale Membranoxygenierung), Kanülierungswege, zur Verfügung stehendes technisches Equipment und über die pathophysiologischen Grundlagen im Zusammenhang mit derartiger Technologie, um das individuell auf die Patientenbedürfnisse angepasste Verfahren zu wählen. Dementsprechend kann die Therapie je nach klinischer Situation im Verlauf eskaliert bzw. deeskaliert werden.

Abstract

Extracorporeal lung support (ECLS) is of increasing importance in general thoracic surgery. Different modes of ECLS may be applied in several situations throughout the perioperative phase and are adapted to the individual patientʼs needs and the planned surgical procedures. ECLS is not a static procedure and should be always evaluated according to the present condition of the patient. Therefore, it is essential to understand the pathophysiology of the disease and the different ECLS modes, as well as the different cannulation options, in order to be able to use the different escalation and de-escalation techniques in accordance with the clinical situation.

Schlüsselwörter

extrakorporale Lungenunterstützung - Thoraxchirurgie - Pathophysiologie

Key words

extracorporeal lung support - thoracic surgery - pathophysiology
 

  • Literatur

  • 1 Bartlett RH. John H Gibbon Jr Lecture. Extracorporeal life support: Gibbon fulfilled. J Am Coll Surg 2014; 218: 317-327
    CrossrefPubMedGoogle Scholar
  • 2 Paden ML, Conrad SA, Rycus PT. et al. Extracorporeal Life Support Organization Registry Report 2012. ASAIO J 2013; 59: 202-210
    CrossrefPubMedGoogle Scholar
  • 3 Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol 2014; 63: 2769-2778
    CrossrefPubMedGoogle Scholar
  • 4 Agerstrand CL, Bacchetta MD, Brodie D. ECMO for adult respiratory failure: current use and evolving applications. ASAIO J 2014; 60: 255-262
    CrossrefPubMedGoogle Scholar
  • 5 Abrams D, Brodie D. novel uses of extracorporeal membrane oxygenation in adults. Clin Chest Med 2015; 36: 373-384
    CrossrefPubMedGoogle Scholar
  • 6 Fischer S, Hoeper MM, Tomaszek S. et al. Bridge to lung transplantation with the extracorporeal membrane ventilator Novalung in the veno-venous mode: the initial Hannover experience. ASAIO J 2007; 53: 168-170
    CrossrefPubMedGoogle Scholar
  • 7 Redwan B, Ziegeler S, Freermann S. et al. Intraoperative veno-venous extracorporeal lung support in thoracic surgery: a single-centre experience. Interact Cardiovasc Thorac Surg 2015; 21: 766-772
    PubMedGoogle Scholar
  • 8 Fischer S, Simon AR, Welte T. et al. Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung. J Thorac Cardiovasc Surg 2006; 131: 719-723
    CrossrefPubMedGoogle Scholar
  • 9 Elizur A, Sweet SC, Huddleston CB. et al. Pre-transplant mechanical ventilation increases short-term morbidity and mortality in pediatric patients with cystic fibrosis. J Heart Lung Transplant 2007; 26: 127-131
    CrossrefPubMedGoogle Scholar
  • 10 Mason DP, Thuita L, Nowicki ER. et al. Should lung transplantation be performed for patients on mechanical respiratory support? The US experience. J Thorac Cardiovasc Surg 2010; 139: 765-773.e1
    CrossrefPubMedGoogle Scholar
  • 11 Olsson KM, Simon A, Strueber M. et al. Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation. Am J Transplant 2010; 10: 2173-2178
    CrossrefPubMedGoogle Scholar
  • 12 Fuehner T, Kuehn C, Hadem J. et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 2012; 185: 763-768
    CrossrefPubMedGoogle Scholar
  • 13 Javidfar J, Brodie D, Iribarne A. et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation and recovery. J Thorac Cardiovasc Surg 2012; 144: 716-721
    CrossrefPubMedGoogle Scholar
  • 14 Criner GJ, Cordova F, Sternberg AL. et al. The National Emphysema Treatment Trial (NETT) Part II: Lessons learned about lung volume reduction surgery. Am J Respir Crit Care Med 2011; 184: 881-893
    CrossrefPubMedGoogle Scholar
  • 15 Kostron A, Horn-Tutic M, Franzen D. et al. Repeated lung volume reduction surgery is successful in selected patients. Eur J Cardiothorac Surg 2015; 48: 710-715
    CrossrefPubMedGoogle Scholar
  • 16 Kluge S, Braune SA, Engel M. et al. Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation. Intensive Care Med 2012; 38: 1632-1639
    CrossrefPubMedGoogle Scholar
  • 17 Bein T, Weber F, Philipp A. et al. A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia. Crit Care Med 2006; 34: 1372-1377
    CrossrefPubMedGoogle Scholar
  • 18 Burki NK, Mani RK, Herth FJ. et al. A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD. Chest 2013; 143: 678-686
    CrossrefPubMedGoogle Scholar
  • 19 Redwan B, Ziegeler S, Semik M. et al. Single-site cannulation venovenous extracorporeal CO2 removal as bridge to lung volume reduction surgery in end-stage lung emphysema. ASAIO J 2016; 62: 743-746
    CrossrefPubMedGoogle Scholar
  • 20 Machuca TN, Cypel M, Keshavjee S. Cardiopulmonary bypass and extracorporeal life support for emergent intraoperative thoracic situations. Thorac Surg Clin 2015; 25: 325-334
    CrossrefPubMedGoogle Scholar
  • 21 Brunelli A, Charloux A, Bolliger CT. et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J 2009; 34: 17-41
    CrossrefPubMedGoogle Scholar
  • 22 Brunelli A, Charloux A, Bolliger CT. et al. The European Respiratory Society and European Society of Thoracic Surgeons clinical guidelines for evaluating fitness for radical treatment (surgery and chemoradiotherapy) in patients with lung cancer. Eur J Cardiothorac Surg 2009; 36: 181-184
    CrossrefPubMedGoogle Scholar
  • 23 Redwan B, Semik M, Dickgreber N. et al. Single site cannulation veno-venous extracorporeal lung support during pulmonary resection in patients with severely compromised pulmonary function. ASAIO J 2015; 61: 366-369
    CrossrefPubMedGoogle Scholar
  • 24 Redwan B, Ziegeler S, Dickgreber N. et al. Metastasectomy in a lung graft using high-flow venovenous extracorporeal lung support in a patient after single lung transplantation. J Thorac Cardiovasc Surg 2015; 150: e79-81
    CrossrefPubMedGoogle Scholar
  • 25 de Perrot M, Fadel E, Mussot S. et al. Resection of locally advanced (T4) non-small cell lung cancer with cardiopulmonary bypass. Ann Thorac Surg 2005; 79: 1691-1696
    CrossrefPubMedGoogle Scholar
  • 26 Pinto CA, Marcella S, August DA. et al. Cardiopulmonary bypass has a modest association with cancer progression: a retrospective cohort study. BMC Cancer 2013; 13: 519
    CrossrefPubMedGoogle Scholar
  • 27 Lang G, Ghanim B, Hotzenecker K. et al. Extracorporeal membrane oxygenation support for complex tracheo-bronchial procedures. Eur J Cardiothorac Surg 2015; 47: 250-256
    CrossrefPubMedGoogle Scholar
  • 28 Lang G, Taghavi S, Aigner C. et al. Extracorporeal membrane oxygenation support for resection of locally advanced thoracic tumors. Ann Thorac Surg 2011; 92: 264-270
    CrossrefPubMedGoogle Scholar
  • 29 Hong Y, Jo KW, Lyu J. et al. Use of venovenous extracorporeal membrane oxygenation in central airway obstruction to facilitate interventions leading to definitive airway security. J Crit Care 2013; 28: 669-674
    CrossrefPubMedGoogle Scholar
  • 30 Ko M, dos Santos PR, Machuca TN. et al. Use of single-cannula venous-venous extracorporeal life support in the management of life-threatening airway obstruction. Ann Thorac Surg 2015; 99: e63-e65
    CrossrefPubMedGoogle Scholar
  • 31 Kodama K, Higashiyama M, Yokouchi H. et al. [Use of percutaneous cardiopulmonary support (PCPS) for extended surgery in patients with T4 tumor]. Kyobu Geka 2000; 53: 721-725
    PubMedGoogle Scholar
  • 32 Kondo T, Sagawa M, Sato M. et al. Left sleeve pneumonectomy performed through a clamshell incision with extracorporeal membrane oxygenation for bronchogenic carcinoma: report of two cases. Surg Today 1999; 29: 807-810
    CrossrefPubMedGoogle Scholar
  • 33 Schiff JH, Koninger J, Teschner J. et al. Veno-venous extracorporeal membrane oxygenation (ECMO) support during anaesthesia for oesophagectomy. Anaesthesia 2013; 68: 527-530
    CrossrefPubMedGoogle Scholar
  • 34 Schneider L, Farrokhyar F, Schieman C. et al. Pneumonectomy: the burden of death after discharge and predictors of surgical mortality. Ann Thorac Surg 2014; 98: 1976-1981
    CrossrefPubMedGoogle Scholar
  • 35 Ruffini E, Parola A, Papalia E. et al. Frequency and mortality of acute lung injury and acute respiratory distress syndrome after pulmonary resection for bronchogenic carcinoma. Eur J Cardiothorac Surg 2001; 20: 30-36
    CrossrefPubMedGoogle Scholar
  • 36 Guerin C, Reignier J, Richard JC. et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368: 2159-2168
    CrossrefPubMedGoogle Scholar
  • 37 Peek GJ, Mugford M, Tiruvoipati R. et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374: 1351-1363
    CrossrefPubMedGoogle Scholar
  • 38 Gattinoni L, Chiumello D, Russo R. Reduced tidal volumes and lung protective ventilatory strategies: where do we go from here?. Curr Opin Crit Care 2002; 8: 45-50
    CrossrefPubMedGoogle Scholar
  • 39 Del Sorbo L, Goffi A, Goligher E. et al. Setting mechanical ventilation in ARDS patients during VV-ECMO: where are we?. Minerva Anestesiol 2015; 81: 1369-1376
    PubMedGoogle Scholar
  • 40 Camboni D, Philipp A, Lubnow M. et al. Extracorporeal membrane oxygenation by single-vessel access in adults: advantages and limitations. ASAIO J 2012; 58: 616-621
    CrossrefPubMedGoogle Scholar
  • 41 Napp LC, Kuhn C, Hoeper MM. et al. Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults. Clin Res Cardiol 2016; 105: 283-296
    CrossrefPubMedGoogle Scholar
  • 42 Biscotti M, Lee A, Basner RC. et al. Hybrid configurations via percutaneous access for extracorporeal membrane oxygenation: a single-center experience. ASAIO J 2014; 60: 635-642
    CrossrefPubMedGoogle Scholar
  • 43 Javidfar J, Brodie D, Costa J. et al. Subclavian artery cannulation for venoarterial extracorporeal membrane oxygenation. ASAIO J 2012; 58: 494-498
    CrossrefPubMedGoogle Scholar
  • 44 Stohr F, Emmert MY, Lachat ML. et al. Extracorporeal membrane oxygenation for acute respiratory distress syndrome: is the configuration mode an important predictor for the outcome?. Interact Cardiovasc Thorac Surg 2011; 12: 676-680
    CrossrefPubMedGoogle Scholar
  • 45 Napp LC, Brehm M, Kuhn C. et al. Heart against veno-arterial ECMO: Competition visualized. Int J Cardiol 2015; 187: 164-165
    CrossrefPubMedGoogle Scholar