Thoracic surgical procedures supported by a pumpless interventional lung assist.

Abstract

For support of pulmonary function during complex thoracic surgical procedures, especially in respiratory compromised patients, a pumpless interventional lung assist (iLA) was applied. Feasibility and effectiveness for this novel indication were evaluated. Ten patients underwent thoracic surgery with respiratory support by iLA. Indication for iLA application was the need for intraoperative prolonged discontinuation of ventilation (tracheal surgery and lung resections after pneumonectomy [n = 6], and emergency procedures in patients with acute respiratory failure [n = 4]. The pumpless extracorporeal system was inserted percutaneously into the femoral blood vessels before surgery. Blood flow through the iLA, cardiac output, and gas exchange were monitored. In all patients, the surgical procedure was successfully performed because of the support by the pumpless iLA. Mean blood flow across the iLA was 1.58 +/- 0.3 L/min (1.2 L/min to 2.2 L/min). Low-dose norepinephrine was required to maintain sufficient systemic blood pressure. There was a moderate improvement in oxygenation (49 mL/min transfer of O(2)) and a very efficient elimination of carbon dioxide (121 mL/min transfer of CO(2)). Thus, extended periods of apneic oxygenation were possible during surgery. The device was removed immediately after surgery in 6 patients. In 4 patients with severe respiratory insufficiency, the iLA was continued for a mean of 6.8 days to allow for protective postoperative ventilation. The application of pumpless iLA was hemodynamically well tolerated, and allowed for safe procedures in respiratory compromised patients, avoiding the application and consequences of cardiopulmonary bypass or pump-driven extracorporeal membrane oxygenation.