VENO-RIGHT VENTRICULAR EXTRACORPOREAL MEMBRANE-OXYGENATION FOR THORACIC-SURGERY - AN EXPERIMENTAL-STUDY IN DOGS

Background: Although the indications for extracorporeal membrane oxyge nation (ECMO) have been extended, ECMO has yet to be used as a respira tory support system during thoracic surgery. The purpose of this exper imental study was to investigate whether veno-right ventricular (veno- RV) ECMO can be used for thoracic surgery without mechanical ventilati on. Methods: Acute experimental study: Veno-RV ECMO as total lung supp ort was maintained for 60 min without mechanical ventilation in six do gs. A venous drainage cannula was inserted in the superior cavoatrial junction through the right femoral vein and a venous return cannula wa s inserted in the right ventricle through the light jugular vein. The veno-RV ECMO system comprised a centrifugal pump and membrane oxygenat or. Survival model: After veno-RV ECMO had been established in three d ogs, a two-ring thoracic tracheal segment was resected and the trachea l ends were anastomosed by video-assisted thoracic surgery without ven tilation. Results: In the acute study, when the veno-RV ECMO flow was maintained at 100 mL/kg/min, all six dogs remained hemodynamically sta ble and the arterial oxygen saturation was maintained at more than 98% , despite total lung collapse. In the survival study, all three dogs m ade an uneventful postoperative recovery. Conclusion: Video-assisted t racheal surgery can be performed without conventional respiratory supp ort. Veno-RV ECMO as total lung support may become an alternative resp iratory management device for thoracic .