684
KAZUISTIKA4321200011157120176236269319376408468532
/4878200011133
CASE4936200011155117168223
REPORT5184200011157113168230289344
Our331232009755100127
experience34563200974079125167194213254299336376
with38493200975978105150
VV40163200974593
ECMO‑assisted41263200974086151207235274306338357389417457503
surgery:46463200973276103148189216257275
case49383200973575107148
report51033200972667113158185215
series5335320097317299119160192
|5584190011126
35565419001114390
/24348040010732
Anest25118040010752100145178207
intenziv273880400107196794136184221240282
Med.30398040010770115165181
2025;36(1):34-383239804001074487129173186230273297337354369413458487528571
/38558040010732
ANESTEZIOLOGIE39528040010753112156200245290342362425468527586607651
A46248040010753
INTENZIVNÍ4698804001071978123168227277297345405426
MEDICÍNA51468040010770114173194248268327381
www.aimjournal.cz4258040010765133201214257275349367415463490539579598614654693
Presentation4253100015371133194248309382433497548589654727
of11753100015364112
Cases13103100015376140195256310
Between425328001074589117183226271318
February760328001074183132159207247273316
20191092328001074486126163
and1271328001074188137
November14243280010758106145188261310355381
2024,1821328001074486127167181
fifteen20183280010724436798140184232
VV2266328001074696
ECMO‑assisted2378328001074192162222251291324357375407436478527
thoracic425342001072876124151193234252292
surgeries738342001073380107155199225245288322
were10803420010765109135178
done1278342001074997146190
at1488342001074168
St.157734200107416884
Anne’s16813420010753101149193209240
University19413420010757104123164207234268286314357
Hospital23183420010757105139188207235277295
in2634342001071866
Brno.2720342001074673121170185
The425356001074395141
patients594356001075194122142188238266303
included924356001072070112132181232278330
512823560010745
women13553560010767117193239289
and1672356001074292144
101843356001074687
men19583560010775122172
with2157356001076788117167
a23523560010742
mean24223560010776122164214
age2663356001074294140
of2830356001075075
60425370001074490
years.542370001074084125152187204
Seven773370001074287128172221
patients1021370001075092120139184233260296
underwent1344370001074897147192219288332381408
elective1779370001074464109151181201242286
surgery,2092370001073482109158203230273285
including2404370001071968109128177227246295345
five277637000107234485129
lung425384001071966113162
tumor603384001072875148196223
resections842384001072669102146187217235282331363
and1221384001074189137
two1375384001072794141
cases1533384001073980113157190
of1739384001074872
benign1827384001074994141160208256
etiology.209938400107437189137156204253293305
Eight2420384001074260108156182
patients2618384001075091118136179227253288
were4253980010765108135178
operated627398001074898143169211238281331
on982398001074896
urgently:1102398001074875123167215242261301318
one1444398001074896140
with1609398001076584112160
a17933980010741
post‑pneumonectomy1858398001075099133162186237285329377451499548592633663710784823
bronchopleural2705398001075077124172425412001074088137187206250298324366385
fistula,83241200107244477106154172213229
another1083412001074189138165213257284
with1389412001076585113161
a15724120010741
tracheal163641200107285496137185229269288
injury194641200107196786133159202
and2171412001074189138
massive23324120010773114147181199240283
air263841200107415986
leak,2746412001071963103141159
two425426001072895143
with594426001076584112161
empyema,7814260010743117166206249323363379
two1186426001072896143
with1355426001076585113161
pneumothorax1542426001075098142190264312339388436463505544
(abscess2112426001072463112146186229263296
rupture),2434426001072775124152200226269291304
one2764426001074897141
with425440001076584112161
an605440001074189
expanding714440001074483133175223272291339388
bulla,1122440001075098117135176192
and1334440001074088138
one1492440001074796140
with1652440001076584112160
lung1832440001071967115164
lobe2016440001071967117162
necrosis.2198440001074892133160207241259291308
In565454001071967
both653454001074998126174
elective847454001074463107149179198239282
and1149454001074189139
acute1308454001074182129158200
settings,1529454001073377105136155202252285301
the1850454001072876120
Cardiohelp1991454001075193119167186234283327346395
ECMO2407454001074293163224
system2651454001073475109138180254
with425468001076584112161
HLS607468001075797141
heparin769468001074892142184210229277
coated1068468001074087128155198248
sets1337468001073478106141
by1499468001075089
Maquet16104680010770111160208252280
(Getinge1911468001072478123151170218267311
Group)2244468001075683130178227249
were25154680010765108135177
used.2714468001074881125175191
Before425482001074590113161188231
the672482001072876121
surgery809482001073481107155199225268
in1094482001071967
elective1178482001074362106147178196237281
cases,1475482001074082115159193209
we17004820010765109
performed1825482001075095121148196222297341391
percutaneous2233482001074994121159207235277325369418466499
cannulation2748482001074082130425496001074894113153179197245292
under733496001074895144187213
ultrasound96249600107476593119160192240287335383
guidance1361496001074995113162202249289330
directly170749600107496793135175205224263
in1986496001071866
the2067496001072875119
operating2202496001074796141166207234252299348
room.2566496001072672120193209
We27914960010773114
performed425510001075095121148196222297341391
cannulation836510001074082130178225244285312331379427
in1283510001071967
the1370510001072876120
intensive151051000107196794137185218236277320
care1850510001074082108151
unit2021510001074896115143
in2184510001071966
the2271510001072776120
same2411510001073375149193
manner26245100010774115163211255281
for42552400107247198
acute541524001074181129157200
cases.758524001074082115159193210
We9855240010774116
inserted1118524001071967100144171202244294
suction1430524001073380121151170218267
cannulae1714524001074082130178225244285329
23-252060524001074488116154198
F22745240010742
into233352400107196794140
the2491524001072876120
femoral2629524001072367140189216257276
vein425538001074184103150
and593538001074189138
returned74853800107277098146172221265315
cannulae1081538001074081129177225244284328
19-211427538001074381111150189
F16325380010741
to1691538001072874
the1782538001072877121
jugular1920538001071967116164182223249
vein.2187538001074084102150166
We23715380010773115
always2504538001074059124166204238
performed276053800107499412142555200107247198172217267
the717552001072876120
priming86355200107497696169187235285
of1173552001074872
the1270552001072876120
ECMO1416552001074293163224
circuit166555200107405985124172190218
with1909552001076584112160
saline,209555200107337594112160204219
without2339552001076584112161209257286
adding2650552001074190139158206255
any425566001074189127
heparin.569566001074892142183210229277293
We8785660010774116
administered1011566001074090163182229248281309352378421471
only1499566001074896115155
a16715660010741
bolus1728566001075099119166199
of1943566001074872
heparin2032566001074892142183210229277
of2325566001074872
20002414566001074487132178
j26095660010719
prior264456600107507796144171
to2832566001072874
the425580001072876120
cannulation,565580001074081129177225244284311330378427442
leaving1026580001072064104143163211260
patients1305580001075092119138181230256291
completely1616580001074086160210230274301344363403
without2038580001076585113161209258286
anticoagulation2343580001074189116135175221263312360379419447465513562
peri-425594001075095122141169
and621594001074189139
postoperatively.7865940010750100134163210260306332374402421462505525565577
We13905940010774116
started1533594001073362104131162205255
ECMO1815594001074293164225
in2066594001071968
the2160594001072877121
same2308594001073375149194
manner25295940010774115163211256283
in2838594001071967
acute425608001074181129157200
cases,645608001074081114159192208
but873608001075098126
in1019608001071967
the1105608001072876121
intensive124560800107196794136185218236277320
care1585608001074081108151
unit.1755608001074896115143159
In565622001071966
elective648622001074362105146176195235278
cases,942622001074081114158191207
airways116562200107415985152193231265
were14466220010765108134176
secured1639622001073377118165191233283
with1938622001076584111159
orotracheal2113622001074874121148174216256303347387405
intubation253462200107196693140189231257276323372
and425636001074189138
total582636001072875102143162
intravenous76363600107196793120162202245293341390422
anesthesia1204636001074189133167196244288322340381
with1603636001076585113161
propofol1783636001074976123174223247294314
infusion211663600107186690139172190238287
was24216360010765107140
used.2580636001074881125175191
We27906360010773115
monitored4256500010775124173192221269296340391
the843650001072877122
depth992650001075094145173222
of1241650001074973
anesthesia1341650001074290135170199249294328347388
using1756650001074882100149199
the1982650001072877122
bispectral2131650001075170104154200242272300342362
index2520650001071967118163203
(BIS)275065000107247090131155
and425664001074189138
maintained5806640010773114133180207248267315359409
it1006664001071846
at1069664001074168
BIS1154664001074564105
40-60.1275664001074490120167211227
During15186640010758107133152200249
elective1784664001074463107148178197238281
surgery,2082664001073380106155199225268279
we23786640010765108
completely2503664001074087161210230274301344363403
disconnected425678001074967100140187235283327368398440490
patients931678001075091118137180228255290
from123767800107245198172
the1425678001072876120
ventilator1561678001074184132159177196236263310336
once1914678001074896136178
they2109678001072876120159
reached2285678001072669109149197241291
502592678001074487
ml/kg2694678001077492124163211
of425692001074872
ECMO515692001074293163224
blood756692001075070118167217
flow,99169200107234694159171
enabling1180692001074492133182202220268318
them1515692001072876121194
to1727692001072875
remain1819692001072770144184203251
apneic2088692001074090139183201242
throughout2348692001072776102149197247295343391419
the2785692001072876120
entire425706001074492119137164207
procedure.651706001074976123165207257305331374389
In1059706001071967
acute1145706001074181129157200
settings,1364706001073478106136155203252285301
501684706001074487
ml/kg1787706001077392125164212
of2018706001074872
ECMO2109706001074293163224
blood2352706001075069117166217
flow258870600107234694159
was27667060010765106139
usually425720001074881129170189207248
not699720001074997125
enough851720001074392141189239287
to1165720001072875
maintain12667200010774115134182209251270318
sufficient1610720001073482106133153194213257305332
oxygenation1969720001074886129178223271312340359407456
(most2451720001072496145179208
of2685720001074873
the2784720001072877121
patients425734001075193121141186235263299
were7517340010766111138182
septic).961734001073479130158178219243257
Therefore,1245734001074394139166211235284312356371
during1643734001075099126146195246
the1916734001072878123
surgery,2067734001073482109159204231275288
we23827340010766111
selectively252073400107347999145187218238280324344385
intubated42574800107196591138186227253295343
these784748001072774117150193
patients993748001074989116134176223249283
(Robertshaw1292748001072367115163207233263297343383446
endobronchial1753748001074390139186235261307354393440458497516
tube2284748001072874123166
37-412466748001074383105150187
Fr)266874800107416587
and2770748001074087136
performed425762001074993118144191217290333382
one‑lung823762001074794137165185231278326
ventilation1165762001074082129155173191231257275322370
as1550762001074073
well.16387620010764107125143158
Should1812762001074188135182200248
the2076762001072775118
patients2209762001074990116134177224250284
fail250876200107246583101
to2624762001072873
wean27137620010764106145192
off42577600107477198
VV538776001074695
ECMO649776001074292161221
within885776001076583111158176223
241124776001074483
hours,1223776001074795142168202217
our1456776001074795120
plan1592776001074968108155
was17637760010765105138
to1917776001072773
start2006776001073361102128158
anticoagulation2180776001074087114132171217258307353372411438456503551
with2747776001076483110158
heparin3047314001074892142184210229277
at3347314001074168
a34383140010741
target350231400107276995143187215
aPTTr3740314001074186129176197
of3960314001074872
1.5–2405531400107445599145185
fold,426331400107237191140155
contingent4441314001074087135162181229278322371397
on4861314001074897
the4981314001072776120
occurrence5124314001074889128175202229272320361403
of3047328001074872
bleeding.3135328001075069113158208226274323339
However,34903280010757105170213254297323335
we38413280010765108
weaned39663280010765108148196240290
all427232800107416078
elective4367328001074463106148178196237280
cases4664328001074081114158192
from487332800107235198171
ECMO5061328001074293163223
within5301328001076584112160178226
243047342001074484
hours3151342001074896145171205
after337634200107416496138165
surgery.3560342001073481107156200226269281
The3187356001074292136
typical3346356001072871121140181222241
indication3610356001071967116135175217244263311359
for399335600107237198
elective4114356001074463107148178197238282
VV4419356001074696
ECMO‑assisted4539356001074192163223253294327361379412441483533
surgery5096356001073380107155199225268
was53883560010765106139
lung3047370001071967115165
resection3238370001072770104148190220239288337
in3601370001071967
a36953700010741
patient3762370001075092119138182231258
after404637000107416597139166
a42383700010741
previous4306370001075077120161181229277311
resection4643370001072770104148190220239288336
(lobectomy500637000107244492142188229260306381420
or5452370001074875
pneumonectomy)3047384001074996140186258306353396437466512584622644
on3706384001074895
the3817384001072774117
contralateral3950384001074085133159185225243283309351377417435
lung,4401384001071965112160175
where45923840010764112155180222
reduced4830384001072668117163203244293
pulmonary5139384001074996114186233281321346388
reserve3047398001072769103147174218261
makes33253980010773114152195229
one‑lung3571398001074796140169189237285334
ventilation3922398001074184132159178196237264283331379
unsafe.4318398001074896129171194238252
Most45873980010770119152181
of4785398001074872
the4874398001072776120
surgeries5010398001073481107156200226245289323
were53493980010765109135178
performed3047412001075095121148196222297341391
due3462412001074997141
to3627412001072774
lung3725412001071966114164
tumors.3913412001072876149198224259275
Specifically,4212412001074291136177196220240280321340359399411
one4647412001074796140
right‑sided481141200107274695143170194228246295339389
and5224412001074189139
one5387412001074896140
left‑sided304742600107196488121145180199249294345
lobectomy3419426001071968119165207238285360400
were38464260010766110137181
done4054426001074998148193
after427442600107416597141168
a44694260010741
left/right‑sided453742600107196489121156181201251299327352387405455500551
lobectomy,5115426001071968119165207238286361400412
one30474400010749100146
right‑sided322144000107274798148176202237257308354406
wedge36554400010766112164215261
resection3944440001072772107153196227247297348
was43204400010767110144
done44924400010751101151197
in4717440001072069
a48144400010742
patient4884440001075195123143188239267
after517944000107426699144171
left­537844000107206691123149
‑sided304745400107276180129174224
lobectomy,3298454001071967118163205235282357396408
and3732454001074290140
metastasectomy38984540010774119147189223252294327372413444491566605
(malignant4529454001072496137156175225273314362390
melanoma)49454540010774119138179228277351392415
was53864540010766107141
performed3047468001075096124151200228303349400
in3474468001071968
a35694680010741
patient3638468001075093120140185234261
after392746800107416598141168
pneumonectomy41224680010751101146195269319369414456487535610650
(Fig.479946800107246685135152
1).497846800107456376
One50824680010761111156
patient5265468001075193121141185235262
with3047482001076685114163
tracheomalacia323748200107285698139188233283358400419461502521562
had3826482001074990141
lobectomy3993482001072069120166208238286361400
and4420482001074291141
one4588482001074898143
with4758482001076685114163
an4948482001074190
intrathoracic506548200107196895123165193242291319361402421462
goiter3047496001074997116144186213
compressing3277496001074086160210236279313346364412461
the3755496001072876120
trachea,389249600107285496136184228268284
who41934960010765113162
was43714960010765107140
unable4528496001074795136185205249
to4794496001072774
undergo4885496001074795145189215263311
selective521349600107337897141182212231272315
intubation,304751000107196794142191233260279327375391
had3461510001074989139
left362351000107196387119
hemithyroidectomy.3765510001074993166185213261300327374393443487528558605679717729
Finally,4518510001074260108149168186226238
the4779510001072876121
last492351000107196093122
patient,5069510001075091118137181229256272
who53655100010765113162
had3047524001075092143
a32185240010742
history3288524001075069103134182211255
of3571524001074975
three3673524001072979107151198
pneumothoraxes38995240010751102147197273324352402453481524566610646
and4572524001074292144
bullous47435240010752102122141191242276
emphysema,50475240010745121172223263299345421463480
underwent3047538001074896145189216284327375402
bullectomy3469538001075098117135179221251297372410
(Fig.389953800107246583132148
2).406753800107446679
Indications3187552001071967116135175217244263311359392
for359655200107247198
acute3711552001074182130158200
VV3928552001074696
ECMO-assisted4041552001074293164224254295328362380413442484534
surgery4592552001073481107155199226269
were48785520010765108135178
mainly50735520010773114133180199239
infections532955200107196790134175304756600107284795143176
in3241566001071967
the3325566001072876120
field346356600107244387106156
of3636566001074872
ARDS3726566001075298156198
(one3941566001072470118163
lung4121566001071967115164
abscess4303566001074090124164207240274
in4594566001071967
a46795660010740
patient4737566001075091118137181229256
with5011566001076584112160
COVID-1951895660010751109154174232262300338
pneumonia,30475800010750100145194269318368387428444
two3519580001072896145
lung3691580001072068117167
necroses3885580001074994137164212246291326
in4238580001071968
a43335800010741
patient4401580001075193121140185234262
with4690580001076685114163
severe4880580001073480121165192236
community-acquired5143580001074189164239287336356304759400107287098139179227274293319362412
pneumonia,3483594001074998142190263312360379419435
and3941594001074189139
two4103594001072895143
cases4269594001074082115159193
of4485594001074872
empyema).45805940010744117167206249323364386399
The5002594001074292136
remaining5161594001072770143184203250269317366
cases3047608001074081113157190
included3253608001071966106125171220264313
one3582608001074896139
expanding3737608001074383132173220269287335383
bulla4137608001074996115133173
causing4326608001074081128160178225274
respiratory4616608001072669102150169195236263309335378
failure501060800107236583101148174216
necessitating5242608001074892132174207240258304762200107286996115163212
prolonged3285622001075077124144192241290334384
artificial369562200107416798117141161201220260279
ventilation,4000622001074184132159178197237264283331380395
one4421622001074897141
bronchopleural4588622001075077124173213261309360379423471497539558
fistulation517262200107244376105153172213240258306355
after304763600107416496138165
right323363600107264695143170
pneumonectomy3424636001074998142190263312361405446476523597636
(Fig.408163600107236583132148
3),425063600107446579
and4350636001074088138
two4509636001072895143
patients4673636001074991118137181229256291
with4985636001076584112160
iatrogenic516663600107195986113160210254302321361
pneumomediastinum/pneumothorax3047650001075099144192266315390434485504545578608627675723797830878927972102010941143117112191268129613381378
(one4451650001072571120164
post‑intubation46426500010750100133163188208256283332382424451470519568
tracheal523665000107285597138187232272291
trauma,304766400107285596144217258274
one3339664001074897141
pneumothorax3498664001075098142190264312339388436463505545
after406166400107416496138165
failed424466400107236684103147197
drainage).4459664001074975117136184224274318339352
Table4829664001074277127147191
150386640010744
summarizes5100664001073380154227268295314351393427
the3047678001072876120
details3187678001074993121162181199232
for343967800107237198
all355767800107405978
cases.3655678001074081115159192209
There3187692001074292136162205
were34126920010765108135177
no3609692001074897
postoperative3725692001075099132161208258303329371398417458501
complications4246692001074086160210230248288330357376424472505
in4771692001071966
elective4857692001074363107148178197238281
VV5158692001074596
ECMO­5273692001074293164224254
‑assisted3047706001072767101134152185214256306
surgery.3370706001073380106154198225268280
Acute3666706001075392140168210
VV3893706001074696
ECMO‑assisted4006706001074293163223253294327360378411440482532
surgery4555706001073380107155199225268
was48407060010764106139
complicated4996706001074086160210229247288329356398448
in5461706001071967
five304772000107244384128
patients3196720001075091118137181229256291
(two3508720001072450118165
with3695720001076584112160
hemothorax,3877720001074892166214241290338365407446463
one4362720001074896140
with4524720001076584112160
hemoperitoneum,4706720001074892166214264309336355383430478522570644659
one5387720001074896140
with3047734001076583111159
infection322273400107196689132173203221268317
in3555734001071866
the3637734001072875119
groin3772734001074975121140187
at3976734001074067
the4059734001072875119
site419473400107345179121
of4331734001074871
cannula4419734001074081128175222241281
insertion,471673400107196699142169199218265313328
and5060734001074189137
one5214734001074795139
with5369734001076584111159
hematoma3047748001074893167207235281356397
in3470748001071967
the3563748001072877121
area3710748001074168111151
of3887748001074873
the3986748001072876121
iliopsoas413374800107193856104155188237279312
muscle44717480010774122155196215259
after475674800107416596139166
suction4948748001073481121152171219268
cannula5242748001074082130178226245286
malposition).30477620010774114133182231265283311330377426447460
Three3524762001074291118160205
of3746762001074872
these3834762001072876120154198
complications4049762001074086160209229247287329356375423471504
(both4570762001072373122150198
cases4784762001074182115159193
of4993762001074872
hemothorax5082762001074892166214241289338364406446
and3047776001074189138
the3205776001072876120
hemoperitoneum)3345776001074892166215265310336355383430479523571644666
required4030776001072770120167186212255305
acute4355776001074181129157200
surgical4575776001073380107155173214255274
revision.4869776001072669110129162180228277293
Fig.42562001255687137164
1.60562001255478
Metastases728630010768106133176206232276306343374
of111963001074568
malignant1203630010771116135153198244289336361
melanoma,1580630010771110128173219264336381397
labeled199363001071964109148166205250
with225963001076381107152
an242863001074591
arrow25356300107467197141203