Awake Thoracic Surgery with Extracorporeal Membrane Oxygenation

A 75-year old patient with a right sided secondary pneumothorax and prolonged air leak showed upper lobe predominant bullous emphysema. Due to the patients extremely reduced general condition neither an open approach nor a thoracoscopic approach seemed possible. Hence, we performed an awake lung volume reduction surgery with perioperative single site veno-venous extracorporeal membrane oxygenation. No heparin was administered. The extracorporeal membrane oxygenation (ECMO) could be weaned up to the second postoperative day. The further postoperative course was uneventful. This current case suggests that combining awake surgery with extracorporeal membrane oxygenation could be a future concept in extremely compromised patients.