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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg
DOI: 10.1055/s-0043-1770738
Original Thoracic

Outcome of Emergency Pulmonary Lobectomy under ECMO Support in Patients with COVID-19

Ana Beatriz Almeida
1   Department of Surgery, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
,
Michael Schweigert 
1   Department of Surgery, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
,
Peter Spieth
2   Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Sachsen, Germany
,
Attila Dubecz
3   Department of General and Thoracic Surgery, Klinikum Nuremberg, Nuremberg, Germany
,
Marcelo Gama de Abreu
4   Department of Anesthesiology, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, United States
,
Torsten Richter
2   Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Sachsen, Germany
,
Patrick Kellner
5   Department of Anesthesiology and Intensive Care, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
› Author Affiliations Funding None.
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Abstract

Background Not much is known about the results of nonelective anatomical lung resections in coronavirus disease 2019 (COVID-19) patients put on extracorporeal membrane oxygenation (ECMO). The aim of this study was to analyze the outcome of lobectomy under ECMO support in patients with acute respiratory failure due to severe COVID-19.

Methods All COVID-19 patients undergoing anatomical lung resection with ECMO support at a German university hospital were included into a prospective database. Study period was April 1, 2020, to April 30, 2021 (first, second, and third waves in Germany).

Results A total of nine patients (median age 61 years, interquartile range 10 years) were included. There was virtually no preexisting comorbidity (median Charlson score of comorbidity 0.2). The mean interval between first positive COVID-19 test and surgery was 21.9 days. Clinical symptoms at the time of surgery were sepsis (nine of nine), respiratory failure (nine of nine), acute renal failure (five of nine), pleural empyema (five of nine), lung artery embolism (four of nine), and pneumothorax (two of nine). Mean intensive care unit (ICU) and ECMO days before surgery were 15.4 and 6, respectively. Indications for surgery were bacterial superinfection with lung abscess formation and progressive septic shock (seven of nine) and abscess formation with massive pulmonary hemorrhage into the abscess cavity (two of nine). All patients were under venovenous ECMO with femoral-jugular configuration. Operative procedures were lobectomy (eight) and pneumonectomy (one). Weaning from ECMO was successful in four of nine. In-hospital mortality was five of nine. Mean total ECMO days were 10.3 ± 6.2 and mean total ICU days were 27.7 ± 9.9. Mean length of stay was 28.7 ± 8.8 days.

Conclusion Emergency surgery under ECMO support seems to open up a perspective for surgical source control in COVID-19 patients with bacterial superinfection and localized pulmonary abscess.

Keywords

COVID-19 - ECMO - thoracic surgery - lung abscess

Note

This study was presented at the 30th European Conference on General Thoracic Surgery in The Hague, The Netherlands, June 19–21, 2022. Also, presented at the SCTS Annual Meeting in Belfast (Northern Ireland, United Kingdom), May 8–10, 2022.




Publication History

Received: 11 December 2022

Accepted: 14 April 2023

Article published online:
03 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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