1. Short-term venoarterial extracorporeal membrane oxygenation for massive endobronchial hemorrhage after pulmonary endarterectomy.
- Author
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Guth S, Wiedenroth CB, Wollenschläger M, Richter MJ, Ghofrani HA, Arlt M, and Mayer E
- Subjects
- Adult, Aged, Anticoagulants administration & dosage, Cardiopulmonary Bypass mortality, Coated Materials, Biocompatible, Endarterectomy mortality, Equipment Design, Feasibility Studies, Female, Heparin administration & dosage, Heparin Antagonists administration & dosage, Hospital Mortality, Humans, Male, Middle Aged, Postoperative Hemorrhage diagnosis, Postoperative Hemorrhage etiology, Postoperative Hemorrhage mortality, Protamines administration & dosage, Severity of Illness Index, Time Factors, Treatment Outcome, Cardiopulmonary Bypass adverse effects, Endarterectomy adverse effects, Extracorporeal Membrane Oxygenation adverse effects, Extracorporeal Membrane Oxygenation instrumentation, Extracorporeal Membrane Oxygenation mortality, Postoperative Hemorrhage therapy, Pulmonary Artery surgery
- Abstract
Objectives: Pulmonary endarterectomy (PEA) is the only curative treatment option for patients with chronic thromboembolic pulmonary hypertension. Massive endobronchial bleeding that precludes weaning from cardiopulmonary bypass is an often-fatal complication of PEA. The aim of this study was to determine whether short-term extracorporeal membrane oxygenation (ECMO) is a safe and feasible procedure in patients with severe endobronchial bleeding., Methods: From January 2014 to December 2016, 396 patients (mean age 60 ± 18 years, 54.5% male) underwent PEA in our department. Patients with severe endobronchial hemorrhage at the time of weaning from cardiopulmonary bypass (CPB) were switched to a heparin-coated venoarterial ECMO circuit. After full-dose protamine administration to restore normal coagulation, weaning from ECMO was attempted in the operating room., Results: In-hospital mortality was 2.3% (9/396 patients). Eight patients (2.0%) developed severe endobronchial bleeding classified as diffuse (n = 6) or localized (n = 2) by bronchoscopy. After reinstitution of CPB and subsequent switch to ECMO, the mean duration of ECMO support was 49 ± 13 minutes, and all 8 patients were weaned successfully from ECMO in the operating theater without further signs of endobronchial bleeding. One patient needed venovenous ECMO support for poor oxygenation 6 hours after surgery. Seven patients were discharged after a prolonged postoperative stay of 17.6 ± 4.1 days. One patient died. This new concept significantly reduced mortality compared with previous (2009-2013) ECMO support (P = .0406)., Conclusions: For patients with massive endobronchial bleeding after PEA, the intraoperative switch from CPB to venoarterial ECMO support with full-dose protamine administration is a new and potentially life-saving treatment concept., (Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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