Veno-Right Ventricular Extracorporeal Membrane Oxygenation for Thoracic Surgery

An Experimental Study in Dogs

¹ From the Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Saga, Japan

Background: Although the indications for extracorporeal membrane oxygenation (ECMO) have been extended, ECMO has yet to be used as a respiratory support system during thoracic surgery. The purpose of this experimental study was to investigate whether veno-right ventricular (veno-RV) ECMO can be used for thoracic surgery without mechanical ventilation.

Methods: Acute experimental study: Veno-RV ECMO as total lung support was maintained for 60 min without mechanical ventilation in six dogs. A venous drainage cannula was inserted in the superior cavoatrial junction through the right femoral vein and a venous return cannula was inserted in the right ventricle through the right jugular vein. The veno-RV ECMO system comprised a centrifugal pump and membrane oxygenator. Survival model: After veno-RV ECMO had been established in three dogs, a two-ring thoracic tracheal segment was resected and the tracheal ends were anastomosed by video-assisted thoracic surgery without ventilation.

Results: In the acute study, when the veno-RV ECMO flow was maintained at 100 mL/kg/min, all six dogs remained hemodynamically stable and the arterial oxygen saturation was maintained at more than 98%, despite total lung collapse. In the survival study, all three dogs made an uneventful postoperative recovery.

Conclusion: Video-assisted tracheal surgery can be performed without conventional respiratory support. Veno-RV ECMO as total lung support may become an alternative respiratory management device for thoracic surgery.

Key Words: thoracic surgery • total lung support • tracheal reconstruction • veno-right ventricular extracorporeal membrane oxygenation

Submitted on September 3, 1997
Accepted on November 10, 1997