Extracorporeal Oxygenation Techniques in Adult Critical Airway Obstruction: A Review.

Michal Pořízka,Basem B Abdelmalak,Jiří Votruba,Pavel Michálek

doi:10.14712/23362936.2021.7

Abstract

Extracorporeal life support has been increasingly utilized in different clinical settings to manage either critical respiratory or heart failure. Complex airway surgery with significant or even total perioperative airway obstruction represents an indication for this technique to prevent/overcome a critical period of severe hypoxaemia, hypoventilation, and/or apnea. This review summarizes the current published scientific evidence on the utility of extracorporeal respiratory support in airway obstruction associated with hypoxaemia, describes the available methods, their clinical indications, and possible limitations. Extracorporeal membrane oxygenation using veno-arterial or veno-venous mode is most commonly employed in such scenarios caused by endoluminal, external, or combined obstruction of the trachea and main bronchi.

Highlights

A complex airway surgery includes a spectrum of interventional bronchological, otorhinolaryngological, and thoracic surgical procedures for various malignant and benign lesions of the upper airway and tracheobronchial tree
A comprehensive electronic and manual search of databases PubMed, Web of Science, and Scopus was performed for a period from January 1980 till April 2020 using the following terms: “extracorporeal oxygenation”, “airway surgery”, “airway obstruction”, “tracheal surgery”
Cardio-pulmonary bypass Historically, the first documented use of conventional cardio-pulmonary bypass (CPB) for airway surgery was published by Woods et al in 1961 and this technique was further used by many centers worldwide (Tyagi et al, 2006)

Summary

Introduction

A complex airway surgery includes a spectrum of interventional bronchological, otorhinolaryngological, and thoracic surgical procedures for various malignant and benign lesions of the upper airway and tracheobronchial tree. Following reconstructive surgery on the tracheobronchial tree, the suture line or the anastomosis site may be at high risk of dehiscence or disruption due to the endotracheal tube presence or pressures exerted by mechanical ventilation (Auchincloss and Wright, 2016) In such circumstances, extracorporeal life support devices including cardio-pulmonary bypass, extracorporeal membrane oxygenation, and pumpless lung assist devices should be utilized. Most ECMO cannulations are carried out after induction of general anaesthesia, in cases of anticipated high likelihood of losing the airway during a complicated endotracheal intubation, awake cannulation can be safely performed (Gardes and Straker, 2012) When used for this indication, patients are usually weaned off and disconnected from ECMO at the end of surgical procedure or within the immediate postoperative period, when definite airway access is secured and native lung function has proven adequate (Lang et al, 2015). In cases of unresolved pulmonary pathology with ongoing respiratory insufficiency or a significant haemodynamic instability, ECMO has to be continued and subsequently weaned off gradually in the postoperative period as the underlying condition improves

Extracorporeal Oxygenation in Airway Obstruction

Findings

Conclusion