Application of extracorporeal membrane oxygenation in bronchoscopic interventional surgery for patients with severe airway stenosis and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CHENG Jiao ¹ , SHI JingYu ² , SUN Peng ² , ZHU Hui ² ,  LI Xiaoou ² , LIU Dan ²

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Xiaoou, Email: lixiaoou86@163.com

Keywords：

Airway stenosis; bronchoscope; extracorporeal membrane oxygenation

DOI：

10.7507/1671-6205.202103013

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the indications, procedures, risks and efficacy of extracorporeal membrane oxygenation (ECMO) in bronchoscopic interventional surgery for patients with severe airway stenosis. Methods Retrospective analysis was performed on 6 patients with severe airway stenosis treated by bronchoscopic surgery under ECMO in West China Hospital from January 2018 to July 2021, and the experience of application was summarized in combination with 23 relevant literatures retrieved. Results Six patients on ECMO successfully completed bronchoscopic interventional surgery with satisfactory intraoperative oxygenation and no obvious hemostasis difficulties were observed. ECMO placement was as an emergency medical countermeasure in 3 patients while the other 3 patients were as preventive purpose. Following treatment, the shortness of breath index and mMRC score decreased and the patients were cured and discharged. During hospitalization, 3 patients had lower extremity deep vein thrombosis, and 1 patient with lower extremity swelling and pain, which was relieved after treatment with low molecular weight heparin. During discharge follow-up, 1 patient died due to airway stenosis, pulmonary infection, and subarachnoid hemorrhage secondary to cardiopulmonary resuscitation, while the other 5 patients did not show any worsening of dyspnea. Combined with the retrieval of 46 similar cases reported in the literature before 2020, it was concluded that these patients who met the application indications of ECMO and followed the shutdown procedure had a good prognosis and controllable risk. Conclusions ECMO can ensure the safety of patients with severe airway stenosis who need undergoing bronchoscopic interventional surgery for patients, improve the success rate of the operation and do not significantly increase the risk of bleeding. However, ECMO is difficult to operate and requires professional team management. Therefore, it is essential to master the indications of application, implement strict withdrawal procedures and necessary monitoring to improve the patient's cure rate and reduce the occurrence of adverse events.

Citation： CHENG Jiao, SHI JingYu, SUN Peng, ZHU Hui, LI Xiaoou, LIU Dan. Application of extracorporeal membrane oxygenation in bronchoscopic interventional surgery for patients with severe airway stenosis and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(7): 498-504. doi: 10.7507/1671-6205.202103013 Copy

1.	Puchalski J, Musani AI. Tracheobronchial stenosis: causes and advances in management. Clin Chest Med, 2013, 34(3): 557-567.
2.	Mahajan AK, Ibrahim O, Perez R, et al. Electrosurgical and laser therapy tools for the treatment of malignant central airway obstructions. Chest, 2020, 157(2): 446-453.
3.	Pandit A, Gupta N, Kumar V, et al. Effect of palliative bronchoscopic interventions on symptom burden in patients with central airway narrowing: a retrospective review. India J Palliat Care, 2019, 25(2): 295-299.
4.	王婷, 张杰, 邱小建, 等. 气管镜下介入治疗瘢痕性气道狭窄的有效性及影响因素分析. 中华结核和呼吸杂志, 2020, 43(9): 784-790.
5.	Doly DJ, Hantzakos AG. Anesthetic management of the narrowed airway. Otolaryngol Clin North Am, 2019, 52(6): 1127-1139.
6.	Murgu SD, Egressy K, Laxmanan B, et al. Central Airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction. Chest, 2016, 150(2): 426-441.
7.	Foong TW, Ramanathan K, Chan KKM, et al. Extracorporeal membrane oxygenation during adult noncardiac surgery and perioperative emergencies: a narrative review. J Cardiothorac Vasc Anesth, 2021, 35(1): 281-297.
8.	Sklar MC, Sy E, Lequier L, et al. Anticoagulation practices during venovenous extracorporeal membrane oxygenation for respiratory failure. a systematic review. Ann Am Thorac Soc, 2016, 13(12): 2242-2250.
9.	Mateen FJ, Muralidharan R, Shinohara RT, et al. Neurological injury in adults treated with extracorporeal membrane oxygenation. Arch Neurol, 2011, 68(12): 1543-1549.
10.	吴洁. 1例气管淀粉样变性行体外膜肺氧合下梗阻疏通的术后护理. 中国实用护理杂志, 2006, 22(16): 59.
11.	Smith LJ, Sidebotham DA, McGeorge AD, et al. Use of extracorporeal membrane oxygenation during resection of tracheal papillomatosis. Anesthesiology, 2009, 110(2): 427-429.
12.	Chen A. ECMO-assisted rigid bronchoscopy for tracheal obstruction. J Bronchology Interv Pulmonol, 2009, 16(4): 296-297.
13.	Collar RM, Taylor JC, Hogikyan N D, et al. Awake extracorporeal membrane oxygenation for management of critical distal tracheal obstruction. Otolaryngol Head Neck Surg, 2010, 142(4): 618-620.
14.	陈愉, 李时悦, 陈德坚, 等. 体外膜肺氧合支持下支气管支架植入救治支气管狭窄合并严重呼吸衰竭一例并文献复习. 中华临床医师杂志(电子版), 2011, 5(14): 4223-4227.
15.	Gourdin M, Dransart C, Delaunois L, et al. Use of venovenous extracorporeal membrane oxygenation under regional anesthesia for a high-risk rigid bronchoscopy. J Cardiothorac Vasc Anesth, 2012, 26(3): 465-467.
16.	Willms DC, Mendez R, Norman V, et al. Emergency bedside extracorporeal membrane oxygenation for rescue of acute tracheal obstruction. Respir Care, 2012, 57(4): 646-649.
17.	Thung AK, Hayes D Jr, Preston TJ, et al. Respiratory support including emergent extracorporeal membrane oxygenation as a bridge to airway dilatation following perioperative bronchial occlusion. Middle East J Anaesthesiol, 2012, 21(6): 879-888.
18.	George TJ, Knudsen KP, Sodha NR, et al. Respiratory support with venovenous extracorporeal membrane oxygenation during stenting of tracheobronchomalacia. Ann Thorac Surg, 2012, 94(5): 1736-1737.
19.	Sang HH, Young EM, Se RL, et al. Anesthetic management for the insertion of a self-expandable metallic tracheal stent under venovenous extracorporeal membrane oxygenation. Korean J Anesthesiol, 2012, 63(6): 569-570.
20.	易丽, 黄絮, 李敏, 等. 体外膜氧合辅助下救治严重气道阻塞2例报告及文献复习. 中国实用内科杂志, 2015, 35(10): 865-867.
21.	Kim JJ, Moon SW, Kim YH, et al. Flexible bronchoscopic excision of a tracheal mass under extracorporeal membrane oxygenation. J Thorac Dis, 2015, 7(3): 54-57.
22.	刘志贞, 陈恩国, 闻胜兰, 等. 体外膜肺氧合支持下经纤维支气管镜介入治疗重度恶性肿瘤性气道狭窄3例. 中华急诊医学杂志, 2016, 25(4): 515-517.
23.	蒲虹, 黄晓波, 黎嘉嘉, 等. 体外膜肺氧合支持在气道重建中的应用体会. 中国呼吸与危重监护杂志. 2016, 15(2): 161-165.
24.	Park JH, Shin JH, Kim KY, et al. Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis. J Thorac Dis, 2017, 9(8): 2599-2607.
25.	Matsumoto R, Mitsuoka M, Hashiguchi T, et al. Temporary airway stenting for giant anterior mediastinal tumor biopsy: two case reports. Int J Surg Case Rep, 2019, 64: 157-160.
26.	Klug TD, Craig J, Shires CB. Awake ECMO without anticoagulation for nearly completely obstructive squamous cell carcinoma of the trachea. Clin Case Rep, 2020, 9(1): 164-168.
27.	Yu W, Zhou PC, Chen KL, et al. Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway: a case report. Medicine (Baltimore), 2020, 99(11): e19488.
28.	Chakalov I, Harnisch LO, Meyer AC, et al. Preemptive veno-venous ECMO support in a patient with anticipated difficult airway: a case report. Respir Med Case Rep, 2020, 30: 101130.
29.	Karim AS, Son AY, Suen R, et al. Pre-intubation veno-venous extracorporeal membrane oxygenation in patients at risk for respiratory decompensation. J Extra Corpor Technol, 2020, 52(1): 52-57.
30.	Kitazawa S, Kobayashi N, Ueda S, et al. Successful use of extracorporeal membrane oxygenation for airway-obstructing lung adenocarcinoma. Thorac Cancer, 2020, 11(10): 3024-3028.
31.	陈成, 王东进. 体外膜肺氧合辅助球囊扩张联合冷冻消融治疗心脏术后气管狭窄一例. 临床外科杂志, 2020, 28(4): 397.
32.	郝泉水, 游丽娟, 吴耀华. 体外膜肺氧合辅助下支气管镜介入治疗危重型新型冠状病毒肺炎合并重度气管狭窄麻醉管理一例. 临床外科杂志, 2020, 28(6): 596-587.
33.	Pathak V, Welsby I, Mahmood K, et al. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc, 2014, 11(4): 628-634.

1. Puchalski J, Musani AI. Tracheobronchial stenosis: causes and advances in management. Clin Chest Med, 2013, 34(3): 557-567.
2. Mahajan AK, Ibrahim O, Perez R, et al. Electrosurgical and laser therapy tools for the treatment of malignant central airway obstructions. Chest, 2020, 157(2): 446-453.
3. Pandit A, Gupta N, Kumar V, et al. Effect of palliative bronchoscopic interventions on symptom burden in patients with central airway narrowing: a retrospective review. India J Palliat Care, 2019, 25(2): 295-299.
4. 王婷, 张杰, 邱小建, 等. 气管镜下介入治疗瘢痕性气道狭窄的有效性及影响因素分析. 中华结核和呼吸杂志, 2020, 43(9): 784-790.
5. Doly DJ, Hantzakos AG. Anesthetic management of the narrowed airway. Otolaryngol Clin North Am, 2019, 52(6): 1127-1139.
6. Murgu SD, Egressy K, Laxmanan B, et al. Central Airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction. Chest, 2016, 150(2): 426-441.
7. Foong TW, Ramanathan K, Chan KKM, et al. Extracorporeal membrane oxygenation during adult noncardiac surgery and perioperative emergencies: a narrative review. J Cardiothorac Vasc Anesth, 2021, 35(1): 281-297.
8. Sklar MC, Sy E, Lequier L, et al. Anticoagulation practices during venovenous extracorporeal membrane oxygenation for respiratory failure. a systematic review. Ann Am Thorac Soc, 2016, 13(12): 2242-2250.
9. Mateen FJ, Muralidharan R, Shinohara RT, et al. Neurological injury in adults treated with extracorporeal membrane oxygenation. Arch Neurol, 2011, 68(12): 1543-1549.
10. 吴洁. 1例气管淀粉样变性行体外膜肺氧合下梗阻疏通的术后护理. 中国实用护理杂志, 2006, 22(16): 59.
11. Smith LJ, Sidebotham DA, McGeorge AD, et al. Use of extracorporeal membrane oxygenation during resection of tracheal papillomatosis. Anesthesiology, 2009, 110(2): 427-429.
12. Chen A. ECMO-assisted rigid bronchoscopy for tracheal obstruction. J Bronchology Interv Pulmonol, 2009, 16(4): 296-297.
13. Collar RM, Taylor JC, Hogikyan N D, et al. Awake extracorporeal membrane oxygenation for management of critical distal tracheal obstruction. Otolaryngol Head Neck Surg, 2010, 142(4): 618-620.
14. 陈愉, 李时悦, 陈德坚, 等. 体外膜肺氧合支持下支气管支架植入救治支气管狭窄合并严重呼吸衰竭一例并文献复习. 中华临床医师杂志(电子版), 2011, 5(14): 4223-4227.
15. Gourdin M, Dransart C, Delaunois L, et al. Use of venovenous extracorporeal membrane oxygenation under regional anesthesia for a high-risk rigid bronchoscopy. J Cardiothorac Vasc Anesth, 2012, 26(3): 465-467.
16. Willms DC, Mendez R, Norman V, et al. Emergency bedside extracorporeal membrane oxygenation for rescue of acute tracheal obstruction. Respir Care, 2012, 57(4): 646-649.
17. Thung AK, Hayes D Jr, Preston TJ, et al. Respiratory support including emergent extracorporeal membrane oxygenation as a bridge to airway dilatation following perioperative bronchial occlusion. Middle East J Anaesthesiol, 2012, 21(6): 879-888.
18. George TJ, Knudsen KP, Sodha NR, et al. Respiratory support with venovenous extracorporeal membrane oxygenation during stenting of tracheobronchomalacia. Ann Thorac Surg, 2012, 94(5): 1736-1737.
19. Sang HH, Young EM, Se RL, et al. Anesthetic management for the insertion of a self-expandable metallic tracheal stent under venovenous extracorporeal membrane oxygenation. Korean J Anesthesiol, 2012, 63(6): 569-570.
20. 易丽, 黄絮, 李敏, 等. 体外膜氧合辅助下救治严重气道阻塞2例报告及文献复习. 中国实用内科杂志, 2015, 35(10): 865-867.
21. Kim JJ, Moon SW, Kim YH, et al. Flexible bronchoscopic excision of a tracheal mass under extracorporeal membrane oxygenation. J Thorac Dis, 2015, 7(3): 54-57.
22. 刘志贞, 陈恩国, 闻胜兰, 等. 体外膜肺氧合支持下经纤维支气管镜介入治疗重度恶性肿瘤性气道狭窄3例. 中华急诊医学杂志, 2016, 25(4): 515-517.
23. 蒲虹, 黄晓波, 黎嘉嘉, 等. 体外膜肺氧合支持在气道重建中的应用体会. 中国呼吸与危重监护杂志. 2016, 15(2): 161-165.
24. Park JH, Shin JH, Kim KY, et al. Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis. J Thorac Dis, 2017, 9(8): 2599-2607.
25. Matsumoto R, Mitsuoka M, Hashiguchi T, et al. Temporary airway stenting for giant anterior mediastinal tumor biopsy: two case reports. Int J Surg Case Rep, 2019, 64: 157-160.
26. Klug TD, Craig J, Shires CB. Awake ECMO without anticoagulation for nearly completely obstructive squamous cell carcinoma of the trachea. Clin Case Rep, 2020, 9(1): 164-168.
27. Yu W, Zhou PC, Chen KL, et al. Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway: a case report. Medicine (Baltimore), 2020, 99(11): e19488.
28. Chakalov I, Harnisch LO, Meyer AC, et al. Preemptive veno-venous ECMO support in a patient with anticipated difficult airway: a case report. Respir Med Case Rep, 2020, 30: 101130.
29. Karim AS, Son AY, Suen R, et al. Pre-intubation veno-venous extracorporeal membrane oxygenation in patients at risk for respiratory decompensation. J Extra Corpor Technol, 2020, 52(1): 52-57.
30. Kitazawa S, Kobayashi N, Ueda S, et al. Successful use of extracorporeal membrane oxygenation for airway-obstructing lung adenocarcinoma. Thorac Cancer, 2020, 11(10): 3024-3028.
31. 陈成, 王东进. 体外膜肺氧合辅助球囊扩张联合冷冻消融治疗心脏术后气管狭窄一例. 临床外科杂志, 2020, 28(4): 397.
32. 郝泉水, 游丽娟, 吴耀华. 体外膜肺氧合辅助下支气管镜介入治疗危重型新型冠状病毒肺炎合并重度气管狭窄麻醉管理一例. 临床外科杂志, 2020, 28(6): 596-587.
33. Pathak V, Welsby I, Mahmood K, et al. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc, 2014, 11(4): 628-634.

Chinese Journal of Respiratory and Critical Care Medicine

Application of extracorporeal membrane oxygenation in bronchoscopic interventional surgery for patients with severe airway stenosis and literature review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content