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Use of extracorporeal membrane oxygenation in non-elective major thoracic surgery for infectious lung abscess.
Schweigert, Michael; Dubecz, Attila; Giraldo Ospina, Carlos F; Spieth, Peter; Almeida, Ana Beatriz; Richter, Torsten; Witzigmann, Helmut; Stein, Hubert J.
Afiliación
  • Schweigert M; Department of Surgery, University Hospital Schleswig-Holstein, Luebeck, Germany.
  • Dubecz A; Department of General and Thoracic Surgery, Klinikum Nuremberg, Nuremberg, Germany.
  • Giraldo Ospina CF; Department of Thoracic Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain.
  • Spieth P; Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany.
  • Almeida AB; Department of Surgery, University Hospital Schleswig-Holstein, Luebeck, Germany.
  • Richter T; Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany.
  • Witzigmann H; Department of General and Thoracic Surgery, Klinikum Dresden, Dresden, Germany.
  • Stein HJ; Department of General and Thoracic Surgery, Klinikum Nuremberg, Nuremberg, Germany.
Eur J Cardiothorac Surg ; 62(4)2022 09 02.
Article en En | MEDLINE | ID: mdl-35213707
OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) support for elective cardiothoracic surgery is well established. In contrast, there are not much data regarding the usefulness and outcome of ECMO in non-elective major lung resections for infectious lung abscess. METHODS: All patients undergoing non-elective major lung surgery for infectious lung abscess at 5 centres in Germany, UK and Spain were enrolled in a prospective database. Malignant disorders and intrathoracic complications of other procedures were excluded. RESULTS: There were 127 patients. The median age was 59 years (interquartile range 18.75). The mean Charlson index of comorbidity was 2.83 (standard deviation 2.57). Surgical procedures were lobectomy (89), pneumectomy (20) and segmentectomy (18). ECMO was used for 10 patients (pneumectomy 2, lobectomy 8) and several more received pre-ECMO treatment. Mortality was 17/127. Intraoperatively no ECMO-associated complications were encountered. EMCO [1/10 vs 16/117; odds ratio (OR): 0.70, 95% confidence interval (CI) 0.08-5.91, P = 0.74] and the extent of pulmonary resection were not associated with higher mortality. Preoperative sepsis (OR: 17.84, 95% CI 2.29-139.28, P < 0.01), preoperative air leak (OR: 13.12, 95% CI 4.10-42.07, P < 0.001), acute renal failure (OR: 7.00, 95% CI 2.19-22.43, P < 0.01) and Charlson index of comorbidity ≥3 (OR: 10.83, 95% CI 2.36-49.71, P < 0.01) were associated with significantly higher mortality. CONCLUSIONS: The application of ECMO is widening the possibilities for successful surgical management of infectious, non-malignant lung abscesses. Particularly, patients with marginal functional operability benefit from the availability and readiness to use ECMO. Mortality is determined by the burden of pre-existent comorbidity, severe sepsis and septic shock.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cirugía Torácica / Oxigenación por Membrana Extracorpórea / Sepsis / Procedimientos Quirúrgicos Torácicos / Absceso Pulmonar Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans / Middle aged Idioma: En Revista: Eur J Cardiothorac Surg Asunto de la revista: CARDIOLOGIA Año: 2022 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cirugía Torácica / Oxigenación por Membrana Extracorpórea / Sepsis / Procedimientos Quirúrgicos Torácicos / Absceso Pulmonar Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans / Middle aged Idioma: En Revista: Eur J Cardiothorac Surg Asunto de la revista: CARDIOLOGIA Año: 2022 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Alemania