ANESTHETIC MANAGEMENT DURING OPEN SURGERY OF THORACOABDOMINAL ANEURYSM REPAIR WITH EXTRACORPOREAL MEMBRANE OXYGENATION. OUR EXPERIENCE IN 13 CASES.
AUTHORS: Bueno L., Pérez P., Fossati S., Beltrao R., Serrano J., Aguilar C.
Background and Goal of the study: 
Open repair of thoracoabdominal aortic aneurysms (ORTAAA) is one of the most demanding interventions due to the compromise of the visceral and renal blood flow.
Classical approaches to reduce complications derived from ischemia times are simple aortic clamping technique or the left cavities bypass. Extracorporeal membrane oxygenation (ECMO) offers advantages in addition to the reduction ischemia times: intervention on patient's temperature, oxygenation of the patient without ventilating the lungs, or decrease in surgical exposure.
The aim of our study is to describe the anesthetic management of 13 patients undergoing ORTAAA using ECMO, as well as to identify a potential decrease in perioperative complications and predictors of them.
Material and Methods:
A series of cases of 13 patients, collected from 2015 to 2017, submitted to ORTAAA through ECMO. We analyze the predictors of paraplegia and acute renal failure (ARF) using the Pearson Chi-square test.
They were performed through balanced general anesthesia with univent bronchial blocker, invasive monitoring (radial artery, femoral artery, pulmonary artery catheter and central vein catheter), epidural catheter and cerebrospinal fluid drainage system. 
Vein and femoral artery were dissected and cannulated for circulation by ECMO. The surgical approach was performed by thoracofrenolaparotomy, repairing the aneurysm and installing the prosthesis usually from the thoracic aorta, although it depends on the type of aneurysm (usually type 3), to abdominal aorta, iliac or femoral bifuration.
Results and discussion:
Ischemia time was less than 30 minutes in 6 cases; In 6 cases between 30-60 minutes; and in 1 case above 60 minutes.
Postoperative complications were 2 cases of paraplegia, 11 ARF (2 required renal replacement therapy); 3 atrial fibrillation; 3 prolonged mechanical ventilation (2 required tracheostomy). 2 patients died.
ECMO times greater than 90 minutes make 1.2 times (OR = 8.33) more likely to suffer RF. 100% of patients with a time greater than 60 minutes had paraplegia, and 16.7% with time less than 30 minutes. These results are not significant (P> 0.04).
Conclusions:
In our experience, although it would be necessary to increase the sample size in order to establish a statistical significance, we could conclude that performing this surgery by ECMO seems to reduce perioperative complications due to the decrease in ischemia times, what could improve the patient prognosis.


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