Comparison of mechanical cardiopulmonary support strategies during lung transplantation

Weingarten, Noah; Schraufnagel, Dean P.; Plitt, Gilman; Zaki, Anthony; Ayyat, K.S.; Elgharably, Haytham

doi:10.1080/17434440.2020.1841630

Cited by 12 publications

(13 citation statements)

References 91 publications

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“…CPB offers benefit of offloading volume from the RV to deter RV failure in pulmonary hypertension patients. 13 In addition, CPB is appropriate for concomitant cardiac surgery. 13…”

Section: Discussionmentioning

confidence: 99%

“…12 Historically, CPB was the main ECLS utilized for LTx. 13 CPB provides gas exchange as well as full hemodynamic support during surgery. CPB offers benefit of offloading volume from the RV to deter RV failure in pulmonary hypertension patients.…”

Section: Preoperative Ecmo Bridge To Ltxmentioning

confidence: 99%

“…CPB offers benefit of offloading volume from the RV to deter RV failure in pulmonary hypertension patients. 13 In addition, CPB is appropriate for concomitant cardiac surgery. 13 The disadvantages of CPB are related to biomaterialinduced inflammatory mediators and complement activation, which can lead to coagulopathy.…”

Section: Preoperative Ecmo Bridge To Ltxmentioning

confidence: 99%

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Perioperative Circulatory Support and Management for Lung Transplantation: A Case-Based Review

Liang

Fritz

Martin

2022

Semin Cardiothorac Vasc Anesth

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Lung transplantation (LTx) historically was performed with cardiopulmonary bypass (CPB) or Off-pump. Recent data suggest an increased interest in extracorporeal membrane oxygenation (ECMO) as perioperative circulatory support by many lung transplantation centers worldwide. However, there are no established guidelines for anesthetic management for LTx. We present a patient with a history of systemic sclerosis and interstitial lung disease complicated by acute onset of systemic pulmonary hypertension and right heart failure undergoing LTx. We aim to discuss perioperative circulatory support, including ECMO bridge to LTx, and how best to consider the varied intraoperative strategies of CPB vs ECMO vs off-pump during LTx, intraoperative maintenance, and coagulation management.

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“…CPB offers benefit of offloading volume from the RV to deter RV failure in pulmonary hypertension patients. 13 In addition, CPB is appropriate for concomitant cardiac surgery. 13…”

Section: Discussionmentioning

confidence: 99%

Section: Preoperative Ecmo Bridge To Ltxmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative Circulatory Support and Management for Lung Transplantation: A Case-Based Review

Liang

Fritz

Martin

2022

Semin Cardiothorac Vasc Anesth

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“…The lowest survival rates were achieved in CPB group (74%; 65.9% and 57.7%). According to Weingarten et al [ 19 ] who analyzed several studies related to comparison between outcomes of CPB and ECMO, there is no difference between short-term mortality of these two machines. In case of medium- and long-term mortality, it is increased for CPB.…”

Section: Discussionmentioning

confidence: 99%

Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation

Ruszel

Kiełbowski

Piotrowska

et al. 2021

J Cardiothorac Surg

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Background Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications. Methods We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan–Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables. Results The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups. Conclusions The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable.

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“… 18 Although use of cardiopulmonary bypass is potentially associated with worse outcomes in lung transplantation, due to the high incidence of pulmonary hypertension, right ventricular dysfunction, and pleural adhesions in patients with COVID-19 associated ARDS, surgeons should use intraoperative cardiopulmonary support when performing these transplants. 17 , 42 VA-ECMO can be used in place of cardiopulmonary bypass to reduce total blood loss and need for blood transfusion which are anticipated with cardiopulmonary bypass. 43 , 44 , 45 However, in patients that have extensive and thick pleural adhesions, there is a possibility of entraining air in the ECMO circuit during the dissection.…”

Section: Nature Of the Problemmentioning

confidence: 99%

Lung Transplantation in Coronavirus-19 Patients

Cerier

Lung

Kurihara

et al. 2023

Clinics in Chest Medicine

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Comparison of mechanical cardiopulmonary support strategies during lung transplantation

Cited by 12 publications

References 91 publications

Perioperative Circulatory Support and Management for Lung Transplantation: A Case-Based Review

Perioperative Circulatory Support and Management for Lung Transplantation: A Case-Based Review

Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation

Lung Transplantation in Coronavirus-19 Patients

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