Blood Products Transfusion and Mid-Term Outcomes of Lung Transplanted Patients Under Extracorporeal Membrane Oxygenation Support

Pettenuzzo, Tommaso; Faggi, Giulio; Gregorio, Guido Di; Schiavon, Marco; Marulli, Giuseppe; Gregori, Darío; Rea, Federico; Ori, Carlo; Feltracco, Paolo

doi:10.1177/1526924818765816

Cited by 14 publications

(7 citation statements)

References 31 publications

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“…In contrast, a smaller (n = 52) retrospective study by Pettenuzzo et al 84 suggested slightly worse outcomes across multiple measures associated with ECMO compared with a cohort undergoing transplant without MCS. Importantly, ECMO was only instituted for significant pulmonary hypertension, impaired gas exchange, or hemodynamic instability, so there may have been selection bias because the ECMO group demonstrated a significantly higher incidence of baseline pulmonary hypertension.…”

Section: Lung Transplantationmentioning

confidence: 83%

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Tawil

Adams

Nicoara

et al. 2019

Semin Cardiothorac Vasc Anesth

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Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.

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Section: Lung Transplantationmentioning

confidence: 83%

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Tawil

Adams

Nicoara

et al. 2019

Semin Cardiothorac Vasc Anesth

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“…On its face, ECMO has a number of perceived benefits over cardiopulmonary bypass. With this in mind, there have been a number of studies comparing the efficacy of ECMO to cardiopulmonary bypass in the lung transplant setting [43][44][45][46][47][48][49][50].…”

Section: Ecmo In the Peri-and Postoperative Period 41 Ecmo Versus Camentioning

confidence: 99%

“…Outcomes compared between patients requiring intraoperative ECMO versus those not requiring any support are less conclusive; in a 2018 study of 53 patients, while patients who underwent ECMO received more intraoperative transfusions, outside of the immediate postoperative period there were no differences in in-hospital and 6-month complications with similar survival between the two groups [50]. In contrast, however, a 2017 single institution study demonstrated 5-year survival to be 52.8% in intraoperative ECMO recipients versus 70.5% in those not requiring ECMO, with multivariate analysis identifying intraoperative ECMO support as significant risk factors for overall survival [46].…”

Section: Ecmo In the Peri-and Postoperative Period 41 Ecmo Versus Camentioning

confidence: 99%

Advances in Extracorporeal Membrane Oxygenation in the Setting of Lung Transplantation

Mazzei¹,

Keshavamurthy²,

Toyoda³

2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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Lung transplantation has become an increasingly important modality for the treatment of severe lung disease. From its inception, the procedure has been refined so that it now represents the standard of care for end stage respiratory failure. The widespread adoption of this treatment option, however, has brought into sharp relief the current organ donor shortage. In tandem with the explosion in lung transplant procedures, a number of support modalities have seen an expanded role. Perhaps one of the most versatile tools in the armamentarium of the pulmonary transplant surgeon is extracorporeal membrane oxygenation (ECMO). This powerful tool is being increasingly implemented in all stages of lung transplantationfrom supporting the failing native organ as a bridging tool to transplantation, to stabilizing the patient intra-operatively during the transplant procedure, to rescuing the patient with severe primary graft dysfunction immediately post-transplant. A number of advanced techniques for the application of ECMO in order to optimize the pulmonary transplant procedure are gaining traction-and with ECMO's expanded role in lung transplantation, so also has come a new set of technical and ethical challenges that must also be overcome.

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“…Since 2010, several case series and meta-analyses have demonstrated the superiority of ECMO vs. CPB for intraoperative support and better outcomes in lung transplantation (Table 2) (8)(9)(10)(11)13,14,(57)(58)(59)(60). Some authors have recently proposed the routine use of intraoperative ECMO in lung transplantation, in order to allow controlled perfusion and protective ventilation of the graft during transplantation and thus reduce the risk of later PGD (14,57).…”

Section: Ecmo For Intraoperative Supportmentioning

confidence: 99%

“…The integration of multidisciplinary team work (ECLS team) with the development of standardized management protocols and new technologies has yielded the good results of modern ECLS support (Figure 1), that have recently been published (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Thus, ECLS use has broadened from pretransplant bridging and post-transplant rescue therapy, to elective postoperative extension of intraoperative ECLS support in patients with idiopathic pulmonary arterial hypertension (16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal support, during and after lung transplantation: the history of an idea

Ius¹,

Tudorache²,

Warnecke³

2018

J. Thorac. Dis.

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During recent years, continuous technological innovation has provoked an increase of extracorporeal life support (ECLS) use for perioperative cardiopulmonary support in lung transplantation. Initial results were disappointing, due to ECLS-specific complications and high surgical risk of the supported patients. However, the combination of improved patient management, multidisciplinary team work and standardization of ECLS protocols has recently yielded excellent results in several case series from high-volume transplant centres. Therein, it was demonstrated that, although the prevalence of complications remains higher in supported patients, there may be no difference in long-term graft function between supported and non-supported patients. These results are important, because most of the patients who require ECLS support in lung transplantation are young and have no other chance to survive, but to be transplanted. Moreover, there is no device for "bridging to destination" therapy in lung transplantation. Of note, the evidence in favour of ECLS support in lung transplantation was never validated by randomized controlled trials, but by everyday experience at the patient bed-side. Here, we review the state-of-the-art ECLS evidence for intraoperative and postoperative cardiopulmonary support in lung transplantation.

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Blood Products Transfusion and Mid-Term Outcomes of Lung Transplanted Patients Under Extracorporeal Membrane Oxygenation Support

Abstract: In our experience, despite the higher need for intraoperative transfusions, lung transplantation performed with ECMO support is comparable to the off-pump procedure as to short-term survival and outcomes.

Cited by 14 publications

References 31 publications

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Advances in Extracorporeal Membrane Oxygenation in the Setting of Lung Transplantation

Extracorporeal support, during and after lung transplantation: the history of an idea

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