Extracorporeal Life Support and Cardio-Pulmonary Bypass for Central Airway Surgery: A Systematic Review
Abstract
Background
Major airway surgery can pose a complex problem to perioperative central airway management. Adjuncts to advanced ventilation strategies have included cardiopulmonary bypass (CPB), veno-arterial (VA-ECLS) or veno-venous extracorporeal life support (VV-ECLS). 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 ECLS during central airway surgery. 36 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. 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 = 0.54).
Conclusions
ECMO offers versatility in timing, surgical approach, and ECLS runtime that make it a viable addition to the surgical armamentarium for treating complex central airway pathologies.