Faculty Collaboration Database

Perioperative Anesthetic and Transfusion Management of Veno-Venous Extracorporeal Membrane Oxygenation Patients Undergoing Noncardiac Surgery: A Case Series of 21 Procedures. J Cardiothorac Vasc Anesth 2019 Jul;33(7):1855-1862

Date

02/24/2019

Pubmed ID

30795968

DOI

10.1053/j.jvca.2019.01.055

Scopus ID

2-s2.0-85061757572 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

OBJECTIVES: To analyze the perioperative management of veno-venous extracorporeal membrane oxygenation (VV ECMO) in patients undergoing major noncardiac surgical procedures, which is poorly described in the literature. In doing so, perioperative challenges related to hemodynamic instability, impaired gas exchange, bleeding, and coagulopathy will be quantified.

DESIGN: Retrospective, nonrandomized, observational study.

SETTING: A single, university-affiliated, quaternary medical center.

PARTICIPANTS: Fourteen patients who underwent 21 noncardiac surgical procedures during the period of January 1, 2014, through April 1, 2016. Approval for this study was obtained from the Duke University Medical Center Institutional Review Board (study Pro00072723).

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Fifty percent of subjects were alive at 1 year after ECMO cannulation. Anesthetic type was variable with an inhaled anesthetic utilized in 71.4% of events, a presurgical continuous sedative was continued in 81.0% of cases, fentanyl was utilized in 100% of encounters, and midazolam was utilized in 71.4% of encounters. Intraoperatively, 50% of encounters resulted in an oxygen desaturation with a peripheral oxygen saturation assessed by pulse oximetry (S_pO₂)<90%, and 15% of procedures resulted in a S_pO₂ <80%. A vasopressor, most commonly epinephrine, was used during 66.7% of procedures. Intraoperatively, blood was administered in 52.4% of procedures, fresh frozen plasma was administered in 23.8% of procedures, and platelets were administered in 28.6% of procedures. Hemoglobin levels remained stable throughout the perioperative period, averaging 9.5 g/dL preoperatively, 9.7 g/dL immediately postoperatively, and 9.5 g/dL 24 hours after surgery.

CONCLUSIONS: VV ECMO patients can be anesthetized using either inhalational or intravenous anesthetics. Patient hemodynamics, oxygenation, and decarboxylation require frequent interventions, but can typically be optimized to meet clinically acceptable thresholds.

Author List

Fierro MA, Dunne B, Ranney DN, Daneshmand MA, Haney JC, Klapper JA, Hartwig MG, Bonadonna D, Manning MW, Bartz RR

Author

Michael Fierro MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Anesthesia
Arterial Pressure
Blood Transfusion
Extracorporeal Membrane Oxygenation
Female
Humans
Male
Middle Aged
Oxygen
Perioperative Care
Retrospective Studies