Experience with intraoperative extracorporeal membrane oxygenation in lung transplantation: intraoperative indicators

Extracorporeal membrane oxygenation in lung transplant

Authors

Keywords:

Lung transplantation, Intraoperative extracorporeal membrane oxygenation, Mean arterial pressure, Age, Pulmonary arterial pressure, Lung allocation score

Abstract

Background/Aim: Intraoperative extracorporeal membrane oxygenation (ECMO) is being used with increasing frequency in lung transplantation. However, the factors associated with the use of intraoperative ECMO in lung transplant patients are not yet conclusive. In this study, we aimed to determine the effective factors for providing intraoperative ECMO support in patients undergoing lung transplantation. In addition, we aimed to evaluate the effect of ECMO support on morbidity and mortality.

Methods: In this retrospective cohort study evaluating lung transplant patients, patients were divided into two groups: those who received intraoperative ECMO support and those who did not. Demographic data, the lung allocation score (LAS) and pulmonary arterial pressure (PAP), intraoperative data, postoperative complications, duration of mechanical ventilation (MV), length of stay (LOS) in intensive care and hospital, and mortality rates were recorded for both groups. Factors affecting entry to ECMO were analyzed by Multivariate Logistic Regression.

Results: In this period, 51.9% of 87 patients who underwent lung transplantation required intraoperative ECMO. The mean age, LAS, and PAP of the ECMO group were significantly higher than the non-ECMO group (P = 0.043, P = 0.007, and P = 0.007, respectively). In multivariate analysis, it was found that lower MAP averages were a predictive parameter in intraoperative ECMO requirements (OR: 1.091; CI: 1.009-1.179; P = 0.028). The ECMO group’s mechanical ventilation time and hospital mortality were significantly higher than the other group (P = 0.004 and P = 0.025, respectively).

Conclusion: Preoperative indicators of intraoperative ECMO support were determined as age, LAS, and PAP elevation. In addition, low MAP levels and high lactate levels were always determined as intraoperative indicators in lung transplantation until the transition to ECMO support.

Downloads

Download data is not yet available.

References

Zhang R, Xu Y, Sang L, Chen S, Huang Y, Nong L, et al. Factors associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation. Respir Res. 2020 Apr 15;21(1):85. doi: 10.1186/s12931-020-01355-7. DOI: https://doi.org/10.1186/s12931-020-01355-7

Biscotti M, Yang J, Sonett J, Bacchetta M. Comparison of extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. J Thorac Cardiovasc Surg. 2014 Nov;148(5):2410-5. doi: 10.1016/j.jtcvs.2014.07.061. DOI: https://doi.org/10.1016/j.jtcvs.2014.07.061

Ius F, Sommer W, Tudorache I, Avsar M, Siemeni T, Salman J, et al. Five-year experience with intraoperative extracorporeal membrane oxygenation in lung transplantation: Indications and midterm results. J Heart Lung Transplant. 2016 Jan;35(1):49-58. doi: 10.1016/j.healun.2015.08.016. DOI: https://doi.org/10.1016/j.healun.2015.08.016

McFadden PM, Greene CL. The evolution of intraoperative support in lung transplantation: Cardiopulmonary bypass to extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2015 Apr;149(4):1158-60. doi: 10.1016/j.jtcvs.2014.12.020. DOI: https://doi.org/10.1016/j.jtcvs.2014.12.020

Cosgun T, Tomaszek S, Opitz I, Wilhelm M, Schuurmans MM, Weder W, et al. Single-center experience with intraoperative extracorporeal membrane oxygenation use in lung transplantation. Int J Artif Organs. 2017 Oct 9:0. doi: 10.5301/IJAO.5000645. DOI: https://doi.org/10.5301/ijao.5000645

Hayanga AJ, Aboagye J, Esper S, Shigemura N, Bermudez CA, D’Cunha J, et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: an evolving strategy in the management of rapidly advancing pulmonary disease. J Thorac Cardiovasc Surg. 2015 Jan;149(1):291-6. doi: 10.1016/j.jtcvs.2014.08.072. DOI: https://doi.org/10.1016/j.jtcvs.2014.08.072

Hoetzenecker K, Benazzo A, Stork T, Sinn K, Schwarz S, Schweiger T, et al; Vienna Lung Transplant Group. Bilateral lung transplantation on intraoperative extracorporeal membrane oxygenator: An observational study. J Thorac Cardiovasc Surg. 2020 Jul;160(1):320-7.e1. doi: 10.1016/j.jtcvs.2019.10.155. DOI: https://doi.org/10.1016/j.jtcvs.2019.10.155

Faccioli E, Terzi S, Pangoni A, Lomangino I, Rossi S, Lloret A, et al. Extracorporeal membrane oxygenation in lung transplantation: Indications, techniques and results. World J Transplant. 2021 Jul 18;11(7):290-302. doi: 10.5500/wjt.v11.i7.290. DOI: https://doi.org/10.5500/wjt.v11.i7.290

Morrison MI, Pither TL, Fisher AJ. Pathophysiology and classification of primary graft dysfunction after lung transplantation. J Thorac Dis. 2017 Oct;9(10):4084-97. doi: 10.21037/jtd.2017.09.09. DOI: https://doi.org/10.21037/jtd.2017.09.09

Hoetzenecker K, Schwarz S, Muckenhuber M, Benazzo A, Frommlet F, Schweiger T, et al. Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation. J Thorac Cardiovasc Surg. 2018 May;155(5):2193-206.e3. doi: 10.1016/j.jtcvs.2017.10.144. DOI: https://doi.org/10.1016/j.jtcvs.2017.10.144

Sunder T. Extracorporeal membrane oxygenation and lung transplantation. Indian J Thorac Cardiovasc Surg. 2021 Apr;37(Suppl 2):327-37. doi: 10.1007/s12055-020-01099-5. DOI: https://doi.org/10.1007/s12055-020-01099-5

Hayes D Jr, Whitson BA, Black SM, Preston TJ, Papadimos TJ, Tobias JD. Influence of age on survival in adult patients on extracorporeal membrane oxygenation before lung transplantation. J Heart Lung Transplant. 2015 Jun;34(6):832-8. doi: 10.1016/j.healun.2014.12.014. DOI: https://doi.org/10.1016/j.healun.2014.12.014

Fang A, Studer S, Kawut SM, Ahya VN, Lee J, Wille K, et al; Lung Transplant Outcomes Group. Elevated pulmonary artery pressure is a risk factor for primary graft dysfunction following lung transplantation for idiopathic pulmonary fibrosis. Chest. 2011 Apr;139(4):782-7. doi: 10.1378/chest.09-2806. DOI: https://doi.org/10.1378/chest.09-2806

Nasir BS, Klapper J, Hartwig M. Lung Transplant from ECMO: Current Results and Predictors of Post-transplant Mortality. Curr Transplant Rep. 2021;8(2):140-50. doi: 10.1007/s40472-021-00323-4. DOI: https://doi.org/10.1007/s40472-021-00323-4

Hayanga JW, D’Cunha J. The surgical technique of bilateral sequential lung transplantation. J Thorac Dis. 2014 Aug;6(8):1063-9. doi: 10.3978/j.issn.2072-1439.2014.07.02.

Hoechter DJ, von Dossow V, Winter H, Müller HH, Meiser B, Neurohr C, et al. The Munich Lung Transplant Group: Intraoperative Extracorporeal Circulation in Lung Transplantation. Thorac Cardiovasc Surg. 2015 Dec;63(8):706-14. doi: 10.1055/s-0035-1556873. DOI: https://doi.org/10.1055/s-0035-1556873

Bermudez CA, Shiose A, Esper SA, Shigemura N, D’Cunha J, Bhama JK, et al. Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation. Ann Thorac Surg. 2014 Dec;98(6):1936-42; discussion 1942-3. doi: 10.1016/j.athoracsur.2014.06.072. DOI: https://doi.org/10.1016/j.athoracsur.2014.06.072

Downloads

Published

2022-08-31

Issue

Section

Research Article

How to Cite

1.
Yiğit Özay H, Turan S. Experience with intraoperative extracorporeal membrane oxygenation in lung transplantation: intraoperative indicators: Extracorporeal membrane oxygenation in lung transplant. J Surg Med [Internet]. 2022 Aug. 31 [cited 2022 Sep. 28];6(8):718-22. Available from: https://jsurgmed.com/article/view/7266