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Posterior Mediastinal Mass Resection Requiring Venoarterial and Venovenous Extracorporeal Membrane Oxygenation Support

Published:January 12, 2021DOI:https://doi.org/10.1053/j.jvca.2021.01.009
      MANAGEMENT OF a large mediastinal mass resection remains a challenging anesthetic scenario due to its compression of airway and major cardiovascular structures. These problems often are exacerbated by general anesthesia. Mediastinal masses usually are designated as anterior, middle, or posterior based on their location in the mediastinum. In general, large anterior mediastinal masses cause the most severe and often life-threatening complications due to the gravity effect leading to a high degree of compression on the trachea, the superior vena cava (SVC), the pulmonary artery, or the right heart. A posterior mediastinal mass usually is considered at lower risk because of its anatomic distance from those vital structures. Here the authors present a case of a large posterior mediastinal mass leading to severe cardiopulmonary compromise, requiring venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for surgical resection and venovenous (VV) ECMO support for postoperative management. Informed consent was obtained from the patient for publication of this case report.

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      References

        • Gardner J.C.
        • Royster R.L.
        Airway collapse with an anterior mediastinal mass despite spontaneous ventilation in an adult.
        Anesth Analg. 2011; 113: 239-242
        • Béchard P.
        • Létourneau L.
        • Lacasse Y.
        • et al.
        Perioperative cardiorespiratory complications in adults with mediastinal mass: Incidence and risk factors.
        Anesthesiology. 2004; 100: 826-834
        • Rath L.
        • Gullahorn G.
        • Connolly N.
        • et al.
        Anterior mediastinal mass biopsy and resection: Anesthetic techniques and perioperative concerns.
        Semin Cardiothorac Vasc Anesth. 2012; 16: 235-242
        • Booka E.
        • Kitano M.
        • Nakano Y.
        • et al.
        Life-threatening giant esophageal neurofibroma with severe tracheal stenosis: A case report.
        Surg Case Rep. 2018; 4: 107
        • Tewari S.
        • Goyal P.
        • Rastogi A.
        • et al.
        Anesthetic challenges of extrinsic trachea-bronchial compression due to posterior mediastinal mass: Our experience with a large esophageal mucocele.
        Ann Card Anaesth. 2017; 20: 359-361
        • Anderson D.M.
        • Dimitrova G.T.
        • Awad H.
        Patient with posterior mediastinal mass requiring urgent cardiopulmonary bypass.
        Anesthesiology. 2011; 114: 1488-1493
        • Vander Els N.J.
        • Sorhage F.
        • Bach A.M.
        • et al.
        Abnormal flow volume loops in patients with intrathoracic Hodgkin's disease.
        Chest. 2000; 117: 1256-1261
        • Hnatiuk O.W.
        • Corcoran P.C.
        • Sierra A.
        Spirometry in surgery for anterior mediastinal masses.
        Chest. 2001; 120: 1152-1156
        • Erdös G.
        • Tzanova I.
        Perioperative anaesthetic management of mediastinal mass in adults.
        Eur J Anaesthesiol. 2009; 26: 627-632
        • Blank R.S.
        • de Souza D.G.
        Anesthetic management of patients with an anterior mediastinal mass: Continuing professional development.
        Can J Anaesth. 2011; 58 (860-7): 853-859
        • Ng J.
        • Hartigan P.M.
        Anterior mediastinal mass.
        in: Hartigan PM Practical handbook of thoracic anesthesia. Springer, New York, NY2012: 336-340
        • Slinger P.
        • Karsli C.
        Management of the patient with a large anterior mediastinal mass: Recurring myths.
        Curr Opin Anaesthesiol. 2007; 20: 1-3
        • Sendasgupta C.
        • Sengupta G
        • Ghosh K
        • et al.
        Femoro-femoral cardiopulmonary bypass for the resection of an anterior mediastinal mass.
        Indian J Anaesth. 2010; 54: 565-568
        • Kim S.H.
        • Song S.
        • Kim Y.D.
        • et al.
        Outcomes of extracorporeal life support during surgery for the critical airway stenosis.
        ASAIO J. 2017; 63: 99-103
        • Lawson D.S.
        • Walczak R.
        • Lawson A.F.
        • et al.
        North American neonatal extracorporeal membrane oxygenation (ECMO) devices: 2002 survey results.
        J Extra Corpor Technol. 2004; 36: 16-21
        • Anastasiadis K.
        • Argiriadou H.
        • Deliopoulos A.
        • et al.
        Minimal invasive extracorporeal circulation (MiECC): The state-of-the-art in perfusion.
        J Thorac Dis. 2019; 11: S1507-S1514
        • Anastasiadis K.
        • Asteriou C.
        • Deliopoulos A.
        • et al.
        Haematological effects of minimized compared to conventional extracorporeal circulation after coronary revascularization procedures.
        Perfusion. 2010; 25: 197-203