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J Heart Lung Transplant. 2018 Dec;37(12):1418-1424. doi: 10.1016/j.healun.2018.07.003. Epub 2018 Sep 5.

Intraoperative extracorporeal support during lung transplantation in patients bridged with venovenous extracorporeal membrane oxygenation.

Author information

1
Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
2
Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
3
Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
4
Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: marcelo.cypel@uhn.ca.

Abstract

BACKGROUND:

Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is the preferred configuration for bridging respiratory failure patients while awaiting lung transplantation. However, there is no consensus on intraoperative extracorporeal cardiopulmonary support during lung transplantation in these patients.

METHODS:

The configuration of the intraoperative extracorporeal circuit after VV ECMO bridge was reviewed and correlated with clinical outcomes. This retrospective cohort study performed at our university hospital included 34 patients who were successfully bridged solely with VV ECMO to lung transplantation during the period 2007 to 2016. Indications to switch to intraoperative venoarterial (VA) ECMO were hemodynamic compromise (systemic hypotension or mean pulmonary artery pressure >40 mm Hg) or when this scenario was thought to be highly likely.

RESULTS:

The median duration of bridging was 12 (IQR 7 to 19) days. Intraoperatively, 3 patients (8.8%) required cardiopulmonary bypass. Twenty patients (58.8%) stayed on VV ECMO and 11 (32.3%) were switched to central VA ECMO. Between the 2 types of intraoperative ECMO (VV vs VA), there were no significant differences in post-operative ECMO duration, chest reopening for bleeding, or renal replacement therapy. There was no significant difference in 90-day mortality (0% and 9.0%, p = 0.35) or in long-term survival (p = 0.59). The intraoperative transfusion of red blood cells tended to be higher in the VA group (5 [4 to 9] vs 8 [6 to 13] units, p = 0.06). Use of intraoperative VA ECMO was associated with the use of low-flow VV device bridging and lobar transplantation.

CONCLUSIONS:

Using the existing VV ECMO bridge intraoperatively during lung transplantation is feasible and provides comparable outcomes to patients converted to central VA ECMO for compromised hemodynamics.

KEYWORDS:

bridge ECMO; extracorporeal membrane oxygenation; lobar transplant; lung transplantation

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