Extracorporeal life support and cardiopulmonary bypass for central airway surgery: A systematic review.

Authors

• Thomas J O'Malley
• Colin C Yost
• Kyle W Prochno
• Abhiraj Saxena
• Tyler R Grenda
• Nathaniel R Evans
• Scott W Cowan
• Rohinton J Morris
• Howard Todd Massey
• Vakhtang Tchantchaleishvili

Publication/Presentation Date

3-1-2022

Abstract

BACKGROUND: Major airway surgery can pose a complex problem to perioperative central airway management. Adjuncts to advanced ventilation strategies have included cardiopulmonary bypass, veno-arterial, or veno-venous extracorporeal life support. We performed a systematic review to assess the existing evidence utilizing these strategies.

METHODS: An electronic search was conducted to identify studies written in English reporting the use of extracorporeal life support (ECLS) during central airway surgery. Thirty-six articles consisting of 78 patients were selected and patient-level data were analyzed.

RESULTS: Median patient age was 47 [IQR: 34-53] and 59.0% (46/78) were male. Indications for surgery included central airway or mediastinal cancer in 57.7% (45/78), lesion or injury in 15.4% (12/78), and stenosis in 12.8% (10/78). Support was initiated pre-operatively in 9.9% (7/71) and at the time of induction in 55.3% (42/76). It was most commonly used at the time of tracheal resection/repair [93.2% (68/73)], intubation of the tracheal stump [94.4% (68/72)], and re-anastomosis [94.2% (65/69)]; 13.7% (10/73) patients were supported post-operatively. The most commonly performed surgery was tracheal repair or resection in 70.3% (52/74). Median hospital stay was 12 [8, 25] days and in-hospital mortality was 7.9% (6/76). There was no significant difference in survival between the three groups (p = .54).

CONCLUSIONS: Extracorporeal membrane oxygenation offers versatility in timing, surgical approach, and ECLS runtime that makes it a viable addition to the surgical armamentarium for treating complex central airway pathologies.

Volume

46

Issue

3

First Page

362

Last Page

374

ISSN

1525-1594

Published In/Presented At

O'Malley, T. J., Yost, C. C., Prochno, K. W., Saxena, A., Grenda, T. R., Evans, N. R., Cowan, S. W., Morris, R. J., Massey, H. T., & Tchantchaleishvili, V. (2022). Extracorporeal life support and cardiopulmonary bypass for central airway surgery: A systematic review. Artificial organs, 46(3), 362–374. https://doi.org/10.1111/aor.14084

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

34633690

Department(s)

Administration and Leadership

Document Type

Article