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128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

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Effective treatment of pulmonary failure with veno-venous extracorporeal membrane oxygenation in a surgical population

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  • Daniele Camboni - Universität Regensburg, Herz-Thorax-Chirurgie, Regensburg
  • Alois Philipp - Universität Regensburg, Herz-Thorax-Chirurgie, Regensburg
  • Matthias Lubnow - Universität Regensburg, Klinik für Innere Medizin II, Regensburg
  • Thomas Müller - Universität Regensburg, Klinik für Innere Medizin II, Regensburg
  • Thomas Bein - Universität Regensburg, Anästhesiologie, Regensburg
  • Hans Stefan Hofman - Universität Regensburg, Thoraxchirurgie, Regensburg
  • Michael Nerlich - Universität Regensburg, Unfallchirurgie, Regensburg
  • Hans Jürgen Schlitt - Universitätsklinikum Regensburg, Klinik und Poliklinik für Chirurgie, Regensburg
  • Christof Schmid - Universität Regensburg, Herz-Thorax-Chirurgie, Regensburg

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch690

doi: 10.3205/11dgch690, urn:nbn:de:0183-11dgch6900

Published: May 20, 2011

© 2011 Camboni et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Introduction: Pulmonary failure (ARDS) is associated with a high mortality. The experience with veno-venous extracorporeal membrane oxygenation (vv-ECMO) in a surgical population is reported.

Materials and methods: A retrospective analysis on n=148 pts requiring vv-ECMO support between April 2006 and September 2010 was applied. Nineteen patients developed ARDS after elective or urgent major surgery (S) including abdominal, orthopaedic and cardiac interventions. Another n=15 patients developed ARDS as a consequence of a severe trauma (T). The non-surgical (NS) population consisted of n=113 pts. Statistical comparisons were executed.

Results: Patients requiring primarily surgery (S) were elder (mean age = 59±13 years) compared to trauma (T) patients requiring surgery (mean age = 32±17 years; p<0.001) and to the non-surgical (NS) population (mean age = 49±16 years; p=0.008). Pulmonary failure was mainly caused by pneumonia, sepsis, aspiration or/and due to chest contusion in several trauma patients. Vv-ECMO support was implemented in n=4 patients (S=2 pts ;T=2 pts) during their primary surgical intervention as a rescue action withholding anticoagulation postoperatively up to 48 hours. In the remaining patients vv-ECMO was installed electively on the intensive care unit after surgery. Oxygenation improved immediately after initiating vv-ECMO, within two hours the PaO2/FiO2 ratio rose from 80±42 mmHg to 129±72 mmHg (p=0.001). Support duration was slightly longer in Spatients compared to Tpatients, but shorter compared to the NSpopulation. Blood and platelet transfusion requirement did not differ between groups (Table 1 [Tab. 1]). The survival to discharge was 48% in the Sgroup compared to 80% in trauma patients (p=0.055). The NSpopulation depicted a survival of 50%.

Conclusion: The outcome in patients suffering from pulmonary failure after major surgery is comparable to the outcome of non- surgical patients also with regards to transfusion requirements. The outcome in trauma patients requiring vv-ECMO is excellent (Figure 1 [Fig. 1]).