European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Sep 2012
Case ReportsMassive haemoptysis on veno-arterial extracorporeal membrane oxygenation.
A 49-year old female presented with severe heart failure with end-organ dysfunction and was placed on veno-arterial extracorporeal membrane oxygenation (ECMO) as a bridge to a decision for end-organ recovery. While on ECMO, the patient developed massive haemoptysis after a Swan-Ganz catheter manipulation. The haemoptysis was not controllable by conventional methods including bronchoscopy with cold saline and epinephrine lavage, bronchial blocker or angiography. ⋯ After the haemoptysis resolved, the endotracheal tube was unclamped. The patient developed adult respiratory distress syndrome and was ventilated using the ARDSnet protocol with continued support from ECMO. On post-ECMO day 20, the patient underwent a successful ECMO wean and a Heart Mate II left ventricular assist device placement.
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Eur J Cardiothorac Surg · Sep 2012
Lung volume reduction surgery for native lung hyperinflation following single-lung transplantation for emphysema: which patients?
Lung transplantation is an established treatment for patients with advanced emphysema. Double-lung transplantation is favoured to avoid complications following single-lung transplantation, including native lung hyperinflation. Nonetheless, single-lung transplantation continues due to limited donor organ availability. The aim of this study was to evaluate the pre-operative assessment, surgical techniques and outcomes in patients undergoing lung volume reduction surgery for native lung hyperinflation. ⋯ Lung volume reduction surgery for native lung hyperinflation is an effective treatment strategy with an acceptable level of surgical risk. Patient selection, however, remains vital. The non-anatomical multiple wedge excision technique used here was as effective as anatomical lung volume reduction surgery used in other series. With regard to pre-operative assessment, the measurement of single-lung inspiratory airflow resistance is of particular interest. We feel that this may provide an additional method of differentiating between native lung hyperinflation and obliterative bronchiolitis prior to surgery, thus improving patient selection.
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Eur J Cardiothorac Surg · Sep 2012
Randomized Controlled Trial Multicenter Study Comparative StudyComplications following lung surgery in the Dutch-Belgian randomized lung cancer screening trial.
To assess the complication rate in participants of the screen arm of the NELSON lung cancer screening trial who underwent surgical resection and to investigate, based on a literature review, whether the complication rate, length of hospital stay, re-thoracotomy and mortality rates after a surgical procedure were different from those of the non-screening series, taking co-morbidity into account. ⋯ In conclusion, mortality rates after surgical procedures are lower in the NELSON lung cancer screening trial than those in the non-screening series. The rate of complications is within the same range as in the non-screening series.