All methods were performed in accordance with the relevant guidelines and regulations, and approved by the Ethics Committee on Biomedical, West China Hospital of Sichuan University (Number: 2021-233). It was a single-center, retrospective small sample study based on real-world. Informed consents were obtained from all patients when they were admitted to our emergency center. The center of West China Hospital, Sichuan University had professional ECMO team and respiratory ICU.
Traditional respiratory supports had extremely limited effect for severe central airway obstruction patients caused by neck and chest tumors.
To explore feasibility of early ECMO initiation as an effective first-aid manner for these patients, we reviewed clinical records of patients between January 2021 and December 2021. Severe central airway obstruction caused by neck and chest tumors, unfeasible traditional respiratory supports and early ECMO intervention were eligible for inclusion. Patients were selected by our respiratory MDT, based on criteria of Practice Guidelines for Management of Difficult Airway (2022 version), presented by American Society of Anesthesiologists (ASA)21 (link),22 (link). 3 patients were completely eligible for inclusion standard. There was no control group. Because it was life-threating for severe central airway obstruction patients caused by neck and chest tumors to use traditional manner. Establishing adequate ventilation was safest for patients. Therefore, we were unable to set control group with traditional manner to compare with ECMO group. We obtained the demographic characteristics, clinical features, blood tests, radiological managements, surgical procedures, pathological examinations, ECMO details and survival outcomes to make a true presentation. Presenting how to build emergency ventilation for severe central airway obstruction patients caused by neck and chest tumors was our primary objective. Central airway obstruction caused by neck and chest tumors is very dangerous oncological emergency with increasing incidence. Discussing an effective first-aid plan to save their life was our secondary objective.
In this part, we showed detailed clinical experience to make that every center could repeat this procedure in the same manner. The primary step was central airway obstruction caused by neck and chest tumors verified by CT performed before treatment. The CT outcomes were interpreted by experienced radiologist or emergency physician. Evaluation and management of difficult airway were performed by anesthesiologist at patient bedside. If traditional managements was useless and even life-threating, ECMO as a significant device could be recommend to provide adequate ventilation. Under ECMO support, surgical procedures were carried out. Conflict between anticoagulation and surgical bleeding should be pay attention. Pharmacokinetics of heparin was important. Kidney played a key role in heparin clearance. Renal function test was significant before using heparin. In our center, firstly, heparin-free was attempted when ECMO was running to provide adequate ventilation. Secondly, coagulation function was tested until reaching surgical standard. Thirdly, surgical procedures were performed during ECMO running without heparin. Lastly, anticoagulation was restarted after operations with acceptable surgical bleeding. All details and variables were recorded.
Traditional respiratory supports had extremely limited effect for severe central airway obstruction patients caused by neck and chest tumors.
To explore feasibility of early ECMO initiation as an effective first-aid manner for these patients, we reviewed clinical records of patients between January 2021 and December 2021. Severe central airway obstruction caused by neck and chest tumors, unfeasible traditional respiratory supports and early ECMO intervention were eligible for inclusion. Patients were selected by our respiratory MDT, based on criteria of Practice Guidelines for Management of Difficult Airway (2022 version), presented by American Society of Anesthesiologists (ASA)21 (link),22 (link). 3 patients were completely eligible for inclusion standard. There was no control group. Because it was life-threating for severe central airway obstruction patients caused by neck and chest tumors to use traditional manner. Establishing adequate ventilation was safest for patients. Therefore, we were unable to set control group with traditional manner to compare with ECMO group. We obtained the demographic characteristics, clinical features, blood tests, radiological managements, surgical procedures, pathological examinations, ECMO details and survival outcomes to make a true presentation. Presenting how to build emergency ventilation for severe central airway obstruction patients caused by neck and chest tumors was our primary objective. Central airway obstruction caused by neck and chest tumors is very dangerous oncological emergency with increasing incidence. Discussing an effective first-aid plan to save their life was our secondary objective.
In this part, we showed detailed clinical experience to make that every center could repeat this procedure in the same manner. The primary step was central airway obstruction caused by neck and chest tumors verified by CT performed before treatment. The CT outcomes were interpreted by experienced radiologist or emergency physician. Evaluation and management of difficult airway were performed by anesthesiologist at patient bedside. If traditional managements was useless and even life-threating, ECMO as a significant device could be recommend to provide adequate ventilation. Under ECMO support, surgical procedures were carried out. Conflict between anticoagulation and surgical bleeding should be pay attention. Pharmacokinetics of heparin was important. Kidney played a key role in heparin clearance. Renal function test was significant before using heparin. In our center, firstly, heparin-free was attempted when ECMO was running to provide adequate ventilation. Secondly, coagulation function was tested until reaching surgical standard. Thirdly, surgical procedures were performed during ECMO running without heparin. Lastly, anticoagulation was restarted after operations with acceptable surgical bleeding. All details and variables were recorded.
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