Five-year experience with intraoperative extracorporeal membrane oxygenation in lung transplantation: Indications and midterm results

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• 作者：Fabio Ius ; MD^a ; Wiebke Sommer ; MD^a ; ^b ; Igor Tudorache ; MD^a ; Murat Avsar ; MD^a ; Thierry Siemeni ; MD^a ; Jawad Salman ; MD^a ; Ulrich Molitoris ; MD^a ; Clemens Gras ; MD^c ; Bjoern Juettner ; MD^c ; Jakob Puntigam ; MSc^a ; Joerg Optenhoefel ; MSc^a ; Mark Greer ; MD^d ; Nicolaus Schwerk ; MD^e ; Jens Gottlieb ; MD^b ; ^d ; Tobias Welte ; MD^b ; ^d ; Marius M. Hoeper ; MD^b ; ^d ; Axel Haverich ; MD^a ; ^b ; Christian Kuehn ; MD^a ; ¹ ; Gregor Warnecke ; MD^a ; ^b ; ¹ ; ^{warnecke.gregor@mh-hannover.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：lung transplantation ; a priori intraoperative ECMO ; non&ndash ; a priori intraoperative ECMO ; patient and graft survival ; multivariate analysis ; risk factors for mortality
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：35
• 期：1
• 页码：49-58
• 全文大小：726 K

文摘

Since April 2010, extracorporeal membrane oxygenation (ECMO) has replaced cardiopulmonary bypass for intraoperative support during lung transplantation at our institution. The aim of this study was to present our 5-year experience with this technique.

Methods

Records of patients who underwent transplantation between April 2010 and January 2015 were retrospectively reviewed. Patients who underwent transplantation without ECMO formed Group A. Patients in whom the indication for ECMO support was set a priori before the beginning of the operation formed Group B. The remaining patients in whom the indication for ECMO support was set during transplantation formed Group C.

Results

Among 595 patients, 425 (71%) patients (Group A) did not require intraoperative ECMO; the remaining 170 (29%) patients did. Among these patients, 95 (56%) patients formed Group B, and the remaining 75 (44%) patients comprised Group C. Pulmonary fibrosis and pre-operative dilated or hypertrophied right ventricle emerged as risk factors for the indication of non–a priori intraoperative ECMO. Patients in Groups B and C showed a higher pre-operative risk profile and higher prevalence of post-operative complications than patients in Group A. Overall survival at 1 year was 93%, 83%, and 82% and at 4 years was 73%, 68%, and 69% in Groups A, B, and C (p = 0.11). The intraoperative use of ECMO did not emerge as a risk factor for in-hospital mortality or mortality after hospital discharge.

Conclusions

Intraoperative ECMO filled the gap between pre-operative and post-operative ECMO in lung transplantation. Although complications and in-hospital mortality were higher in patients who received ECMO, survival was similar among patients who underwent transplantation with or without ECMO.