Table 3 Summary of different extracorporeal devices
From: Extracorporeal support for pulmonary resection: current indications and results
|  | Inconvenient | Longer operations ➢ Cardiac disease have been reported to increase the risk for pulmonary complications following lung resections especially with prolonged use (pulmonary oedema) ➢ Full anticoagulation (ACT >300 s) ➢ Bleeding (transfusion, re-operation) ➢ Activation of inflammatory mediators ➢ Potential danger of tumor cell spilling through the machine suction |
Cardio-pulmonary bypass | Indication | ➢ Total pulmonary support (CO2 extraction and O2) hemodynamic stability and possibility of cardiac arrest |
Advantage | ➢ Complete inspection of infiltrated cardiac or vascular structures allowing for safe resections margins ➢ Intra-operative microscopic control of complete resection ➢ Emergent institution in case of great vessels lesion | |
Inconvenient | Longer operations ➢ Cardiac disease have been reported to increase the risk for pulmonary complications following lung resections especially with prolonged use (pulmonary oedema) ➢ Full anticoagulation (ACT >300 s) ➢ Bleeding (transfusion, re-operation) ➢ Activation of inflammatory mediators ➢ Potential danger of tumor cell spilling through the machine suction | |
Veno-arterial ECMO | Indication | ➢ Total pulmonary support (CO2 extraction and O2) and hemodynamic stability |
Advantage | ➢ No risk of tumor cell dissemination (closed system devoid of cardiotomy suction) ➢ Low anticoagulation (ACT:160-200 s). Cannulae are heparin-coated ➢ Clean operative field without disturbing line ➢ Stability of cardiorespiratory function during heart manipulation ➢ Switch VA to VV ECMO: protective lung ventilation (no pressure on sutures in case of mechanical ventilation with high volumes). VA ECMO can be quickly converted into conventional CPB in case of cardiovascular wound | |
Inconvenient | ➢ Arterial dissection/thrombosis ➢ Acute ischaemia of limb ➢ Myocardial or brain hypoxaemia | |
Veno-venous ECMO | Indication | ➢ Total pulmonary support (CO2 extraction and O2) |
Advantage | ➢ Useful for elective cases if no cardiac failure or cardiac morbidity ➢ No arterial cannulation with no risks of arterial injury ➢ Better myocardial oxygenation ➢ Possibility to maintain post-operatively in case of pulmonary oedema | |
Inconvenient | ➢ Thromboembolic venous disease ➢ Recirculation ➢ Superior cava syndrome | |
Interventional lung assist (Novalung) | Indication | ➢ Partial pulmonary support (CO2 extraction, low oxygenation) |
Advantage | ➢ Pumpless membrane ventilator ➢ Low anticoagulation ➢ Apnea possible with passive endotracheal oxygenation ➢ Peripheral access by percutaneous cannulation | |
Inconvenient | ➢ Vascular access complications (dissection, thrombosis) ➢ Only part of the cardiac output (1–2 L/min) for extracorporeal gas exchange. (Low capacity of oxygenation) ➢ Adequate mean arterial blood pressure is mandatory. It may not be used as: o Low cardiac output o Impaired left ventricular function o High dose catecholamine administration |