33986 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of central cannula(e) by sternotomy or thoracotomy, 6 years and older

Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO)/Extracorporeal Life Support (ECLS) Removal of Central Cannula(e) by Sternotomy or Thoracotomy, 6 Years and Older

Summary

The removal of ECMO/ECLS central cannulae involves taking out the specialized tubes used to provide life support from the patient’s chest through surgical means, either by sternotomy (cutting through the breastbone) or thoracotomy (making an incision in the chest wall). This procedure is done when the patient no longer needs mechanical circulatory or respiratory support.

Purpose

This procedure addresses patients who were reliant on ECMO/ECLS for life support due to severe cardiac or respiratory failure. The goal is to safely remove the cannulae once the patient’s condition has stabilized and they can sustain circulatory and respiratory functions on their own.

Indications

• Patients aged 6 years and older who have been stable on ECMO/ECLS.
• Indicators that cardiac and/or respiratory function has sufficiently recovered to wean off ECMO/ECLS.
• Lack of improvement through medical management alone.

Preparation

• Fasting for several hours before the procedure.
• Adjustments or temporary discontinuation of certain medications, as advised by the physician.
• Preoperative assessments, including blood tests, imaging, and possibly an echocardiogram.
• Consent forms and explanation of the procedure, risks, and benefits.

Procedure Description

1. The patient is taken to the operating room and placed under general anesthesia.
2. The surgical team sterilizes the chest area.
3. Depending on the approach, a sternotomy or thoracotomy incision is made.
4. The surgeon carefully locates and removes the central cannulae.
5. The incision is closed with sutures or staples.
6. The patient is monitored closely during and after the procedure for any signs of complications.

Tools: Surgical scalpel, retractors, sutures, and specialized ECMO removal equipment. Anesthesia: General anesthesia is used to ensure the patient is unconscious and pain-free during the procedure.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity and patient’s condition.

Setting

The procedure is performed in a hospital's operating room.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (if ECMO is still running during the start of the procedure)
• Respiratory therapist

Risks and Complications

• Infection
• Bleeding
• Thrombosis (clotting)
• Pneumothorax (collapsed lung)
• Arrhythmias
• Damage to surrounding structures (heart, lungs, vessels)

Proper management of these complications involves prompt intervention by the surgical team.

Benefits

• Enables the patient to return to normal cardiac and respiratory function without mechanical support.
• Reduces the risk of long-term complications associated with prolonged ECMO/ECLS use.

Recovery

• Intensive monitoring in the ICU for several days.
• Pain management through medications.
• Gradual resumption of physical activities.
• Follow-up appointments to monitor recovery progress.
• Restrictions on strenuous activities for a few weeks.

Alternatives

• Continuing ECMO/ECLS if the patient is not yet stable enough for removal.
• Less invasive methods might be considered for cannula removal if the patient’s condition allows, but they may carry different risk levels.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-procedure, the primary sensations will be related to surgical recovery, such as soreness at the incision site and general discomfort which can be managed effectively with pain medications.