Venoarterial Extracorporeal Membrane Oxygenator Support in Lung Cancer Resection.

Abstract

Cardiovascular comorbidities often prevent patients with otherwise resectable early-stage lung cancer from undergoing surgery due to prohibitive peri-operative risk. Here we describe the first intraoperative use of venoarterial (VA) ECMO in a stage cIIA lung cancer patient with arterial infiltration and severe post-ischemic dilated cardiomyopathy (EF 23%) undergoing left upper lobectomy with pulmonary artery angioplasty. Providing intra-operative cardiovascular and respiratory function support, VA-ECMO represents a suitable option for patients with heart failure, ensuring adequate hemodynamic profile and reducing the risk of complications. These otherwise inoperable patients can thus be offered a potentially curative surgical resection of the malignancy. Surgery is the standard treatment for patients with early-stage lung cancer 1. However, several patients with advanced heart failure may be excluded from surgery due to prohibitive perioperative risk. Providing circulatory and respiratory support, extracorporeal membrane oxygenator (ECMO) may represent a suitable option for such patients 2. While there is a published experience on intraoperative use of veno-venous (VV) ECMO, primarily in thoracic surgery 3, an extremely limited number of reports considered the use of venoarterial (VA)-ECMO in patients undergoing non-cardiac surgery 45. VA-ECMO is currently indicated in patients with cardiovascular failure and concomitant cardiac pump dysfunction, as in post-operative ARDS associated with septic shock 4; outside the intensive care unit, the use of pre-emptive VA-ECMO has traditionally been limited to patients undergoing elective ventricular tachycardia ablation and structural heart procedures5. Here we report the first case of intraoperative use of VA-ECMO in a patient with resectable lung cancer and ischemic heart disease with prohibitive left ventricular function, and describe the benefits of this new indication.