Cargando…
Extracorporeal life support in thoracic emergencies—a narrative review of current evidence
BACKGROUND AND OBJECTIVE: Resuscitative therapies for respiratory and cardiac failure are lifesaving and extended by using extracorporeal life support (ECLS) as mechanical circulatory support (MSC). This review informs the debate to identify the life-threatening thoracic emergencies in which patient...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407525/ https://www.ncbi.nlm.nih.gov/pubmed/37559625 http://dx.doi.org/10.21037/jtd-22-1307 |
_version_ | 1785085983282167808 |
---|---|
author | Willers, Anne Mariani, Silvia Maessen, Jos M. Lorusso, Roberto Swol, Justyna |
author_facet | Willers, Anne Mariani, Silvia Maessen, Jos M. Lorusso, Roberto Swol, Justyna |
author_sort | Willers, Anne |
collection | PubMed |
description | BACKGROUND AND OBJECTIVE: Resuscitative therapies for respiratory and cardiac failure are lifesaving and extended by using extracorporeal life support (ECLS) as mechanical circulatory support (MSC). This review informs the debate to identify the life-threatening thoracic emergencies in which patients may be cannulated for ECLS support. METHODS: An advanced search was performed in PubMed, Embase, Google Scholar, and references query, assessed in June 2022, identified 761 records. Among them, 74 publications in English were included in the current narrative review. KEY CONTENT AND FINDINGS: ECLS is an additional tool for organ support in life-threatening thoracic emergencies. It provides bridging to recovery or to decision about destination as definitive therapy, intervention, or surgery. Non-traumatic emergencies include mediastinal mass, acute lung injury (ALI), aspiration, embolisms, acute and chronic heart failure. However, based on the current evidence, trauma, and especially blunt thoracic trauma, is one of the main indications for ECLS use in thoracic emergencies, among others in chest wall fractures, blunt and penetrating lung injuries. ECLS use is always individualized to patient’s needs, injury pattern and kind of organ failure, circulatory arrest inclusive, depending on if respiratory or cardiac and circulatory support is needed. Further, ECLS offers the possibility for fast volume resuscitation and rewarming, thus preventing the lethal of trauma: hypothermia, hypoperfusion and acidosis. Anticoagulation may be omitted for some hours or days. Interdisciplinary cooperation between the intensivists, surgeons, anesthesiologists, emergency medical services, an appropriately organized and trained staff, equipment resources and logistical planning are essential for successful outcomes. CONCLUSIONS: ECLS use in selected life-threatening thoracic emergencies is increasing. The summarized findings appeal to policymakers, and we hope that our summary of recommendations may impact clinical practice and research. |
format | Online Article Text |
id | pubmed-10407525 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-104075252023-08-09 Extracorporeal life support in thoracic emergencies—a narrative review of current evidence Willers, Anne Mariani, Silvia Maessen, Jos M. Lorusso, Roberto Swol, Justyna J Thorac Dis Review Article on Extracorporeal Life Support in Thoracic Surgery BACKGROUND AND OBJECTIVE: Resuscitative therapies for respiratory and cardiac failure are lifesaving and extended by using extracorporeal life support (ECLS) as mechanical circulatory support (MSC). This review informs the debate to identify the life-threatening thoracic emergencies in which patients may be cannulated for ECLS support. METHODS: An advanced search was performed in PubMed, Embase, Google Scholar, and references query, assessed in June 2022, identified 761 records. Among them, 74 publications in English were included in the current narrative review. KEY CONTENT AND FINDINGS: ECLS is an additional tool for organ support in life-threatening thoracic emergencies. It provides bridging to recovery or to decision about destination as definitive therapy, intervention, or surgery. Non-traumatic emergencies include mediastinal mass, acute lung injury (ALI), aspiration, embolisms, acute and chronic heart failure. However, based on the current evidence, trauma, and especially blunt thoracic trauma, is one of the main indications for ECLS use in thoracic emergencies, among others in chest wall fractures, blunt and penetrating lung injuries. ECLS use is always individualized to patient’s needs, injury pattern and kind of organ failure, circulatory arrest inclusive, depending on if respiratory or cardiac and circulatory support is needed. Further, ECLS offers the possibility for fast volume resuscitation and rewarming, thus preventing the lethal of trauma: hypothermia, hypoperfusion and acidosis. Anticoagulation may be omitted for some hours or days. Interdisciplinary cooperation between the intensivists, surgeons, anesthesiologists, emergency medical services, an appropriately organized and trained staff, equipment resources and logistical planning are essential for successful outcomes. CONCLUSIONS: ECLS use in selected life-threatening thoracic emergencies is increasing. The summarized findings appeal to policymakers, and we hope that our summary of recommendations may impact clinical practice and research. AME Publishing Company 2023-04-04 2023-07-31 /pmc/articles/PMC10407525/ /pubmed/37559625 http://dx.doi.org/10.21037/jtd-22-1307 Text en 2023 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Review Article on Extracorporeal Life Support in Thoracic Surgery Willers, Anne Mariani, Silvia Maessen, Jos M. Lorusso, Roberto Swol, Justyna Extracorporeal life support in thoracic emergencies—a narrative review of current evidence |
title | Extracorporeal life support in thoracic emergencies—a narrative review of current evidence |
title_full | Extracorporeal life support in thoracic emergencies—a narrative review of current evidence |
title_fullStr | Extracorporeal life support in thoracic emergencies—a narrative review of current evidence |
title_full_unstemmed | Extracorporeal life support in thoracic emergencies—a narrative review of current evidence |
title_short | Extracorporeal life support in thoracic emergencies—a narrative review of current evidence |
title_sort | extracorporeal life support in thoracic emergencies—a narrative review of current evidence |
topic | Review Article on Extracorporeal Life Support in Thoracic Surgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407525/ https://www.ncbi.nlm.nih.gov/pubmed/37559625 http://dx.doi.org/10.21037/jtd-22-1307 |
work_keys_str_mv | AT willersanne extracorporeallifesupportinthoracicemergenciesanarrativereviewofcurrentevidence AT marianisilvia extracorporeallifesupportinthoracicemergenciesanarrativereviewofcurrentevidence AT maessenjosm extracorporeallifesupportinthoracicemergenciesanarrativereviewofcurrentevidence AT lorussoroberto extracorporeallifesupportinthoracicemergenciesanarrativereviewofcurrentevidence AT swoljustyna extracorporeallifesupportinthoracicemergenciesanarrativereviewofcurrentevidence |