Veno-venous extracorporeal membrane oxygenation used as an adjunct in the surgical management of acquired and iatrogenic tracheobronchial pathology.

BACKGROUND: Surgical repair of tracheobronchial tree injuries is challenging due to the difficulties associated with providing perioperative ventilatory support. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a recognised treatment modality for managing respiratory failure. Its use has expanded to include offering respiratory support for patients requiring surgery on the tracheobronchial tree. This study presents our experience with V-V ECMO support for elective and emergency surgery for acquired and iatrogenic tracheobronchial pathology.

METHODS: A retrospective review of our single-centre experience of surgical tracheobronchial repairs where V-V ECMO was employed between 2017 and 2020 was undertaken. Preoperative patient characteristics, intra-operative findings, details of ECMO support and postoperative outcomes were collected and analysed.

RESULTS: Five patients underwent surgery with V-V ECMO support during the study period. Indications for surgery included repair of iatrogenic tracheal tear (n=2), repair of iatrogenic gastro-bronchial fistula (n=1), elective tracheoplasty (n=1) and elective resection of tracheal tumour (n=1). The median duration of V-V ECMO was 17 hours (range 4-543 hours), and the median postoperative length of stay was 9 days (range 7-19 days). In-hospital and 90-day mortality were both 0% (n=0). Post-operative complications included reoperation for bleeding (n=1) and thrombotic complications (n=2).

CONCLUSIONS: We have shown how V-V ECMO can be safely utilised to manage patients with a range of tracheobronchial injuries with low rates of postoperative morbidity. Acceptable postoperative outcomes can be achieved for this cohort of clinically complex patients when treatment is provided with a multidisciplinary team approach in high-volume specialist centres.