RESUMO
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 recognized 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-center experience of surgical tracheobronchial repairs where V-V ECMO was employed between 2017 and 2020 was undertaken. Preoperative patient characteristics, intraoperative findings, details of ECMO support and postoperative outcomes were collected and analyzed. 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 tumor (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). Postoperative complications included reoperation for bleeding (N.=1) and thrombotic complications (N.=2). CONCLUSIONS: We have shown how V-V ECMO can be safely utilized 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 centers.
