In 1976, Bartlett et al reported the first successful use of extracorporeal membrane oxygenation (ECMO) for neonatal respiratory failure and ever since, ECMO has been used widely for children and adults suffering severe respiratory’ failure. Whether ECMO is effective when the lungs are totally collapsed is unknown, however. Although the indications for extracorporeal membrane oxygenation (ECMO) have been extended, ECMO has yet to be used as a respiratory support system during thoracic surgery. If ECMO can maintain satisfactory oxygenation without mechanical lung ventilation, it would enable the endobronchial tube to be removed and simplify difficult airway reconstruction surgery.
Therefore, the first experiment was undertaken to investigate the pulmonary hemodynamics and physiology in order to determine the feasibility of using ECMO during lung collapse and in the second experiment, the applicability of ECMO as an alternative to direct operative endobronchial tube ventilation during video-assisted tracheal reconstruction was assessed. canadian health and care mall
Materials and Methods
Acute Experimental Preparation
Six mongrel dogs weighing 17 to 24 kg were used in the acute phase of the study. They were premedicated with IM ketamine hydrochloride, 40 mg/kg body weight. A left radial vein was cannulated for fluid and drug administration and the dogs were anesthetized by administering 5 mg/kg of sodium pentobarbital and 0.1 mg/kg of pancuronium bromide through the cannula. Then, tracheal intubation with a No. 7 endotracheal tube was carried out and the lungs were ventilated mechanically using a volume-cycle respirator (model 671; Shinano Inc; Tokyo, Japan) with an inspired oxygen fraction of 0.4. Ventilation was adjusted to maintain the blood pH and oxygen levels within satisfactory ranges, determined by measuring arterial blood gas levels. The routine respiration rate was 20 breaths/min and the tidal volume was 20 mlVkg body weight. Additional doses of sodium pentobarbital and pancuronium bromide were administered as required to maintain anesthesia. After anesthesia induction, a catheter was inserted in the right femoral artery (FA) for continuous arterial BP measurement and arterial oxygen saturation analysis. A Swan-Ganz catheter (Baxter Healthcare Corp; Santa Ara, Calif) was placed in the pulmonary artery (PA) through a branch of the right jugular vein for mean pulmonary artery pressure (mean PAP) measurement and blood sampling. Through a fifth left intercostal lateral thoracotomy, an IV line catheter (18G IV line; Togo Medikit Co Ltd; Tokyo, Japan) was inserted into the left atrium (LA) from the left atrial appendage for mean left atrial blood pressure (LAP) monitoring and blood sampling.