Newly Published
Review Article  |   October 2017
Perioperative Management of the Adult Patient on Venovenous Extracorporeal Membrane Oxygenation Requiring Noncardiac Surgery
Author Notes
  • From the Department of Anesthesiology (M.A.F., R.R.B), Department of Surgery, Division of Cardiothoracic Surgery (M.A.D.), Department of Medicine (R.R.B.), Duke University Medical Center, Durham, North Carolina.
  • Submitted for publication September 30, 2016. Accepted for publication June 27, 2017.
    Submitted for publication September 30, 2016. Accepted for publication June 27, 2017.×
  • Research Support: Support was provided solely from institutional and/or departmental sources.
    Research Support: Support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Fierro: Duke University Medical Center 3094, Durham, North Carolina 27710. michael.fierro@duke.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Review Article / Coagulation and Transfusion / Renal and Urinary Systems / Electrolyte Balance
Review Article   |   October 2017
Perioperative Management of the Adult Patient on Venovenous Extracorporeal Membrane Oxygenation Requiring Noncardiac Surgery
Anesthesiology Newly Published on October 5, 2017. doi:10.1097/ALN.0000000000001887
Anesthesiology Newly Published on October 5, 2017. doi:10.1097/ALN.0000000000001887
Abstract

The use of venovenous extracorporeal membrane oxygenation is increasing worldwide. These patients often require noncardiac surgery. In the perioperative period, preoperative assessment, patient transport, choice of anesthetic type, drug dosing, patient monitoring, and intraoperative and postoperative management of common patient problems will be impacted. Furthermore, common monitoring techniques will have unique limitations. Importantly, patients on venovenous extracorporeal membrane oxygenation remain subject to hypoxemia, hypercarbia, and acidemia in the perioperative setting despite extracorporeal support. Treatments of these conditions often require both manipulation of extracorporeal membrane oxygenation settings and physiologic interventions. Perioperative management of anticoagulation, as well as thresholds to transfuse blood products, remain highly controversial and must take into account the specific procedure, extracorporeal membrane oxygenation circuit function, and patient comorbidities. We will review the physiologic management of the patient requiring surgery while on venovenous extracorporeal membrane oxygenation.