Extracorporeal membrane oxygenation as an adjunct treatment for primary graft failure in adult lung transplant recipients

Abstract

Primary graft failure is a catastrophic event in lung transplantation. Failure is characterized by profound abnormalities of gas exchange that are frequently unresponsive to alterations in mechanical ventilation. This condition can be fatal and, if less severe, is usually associated with significant permanent damage to the allograft. We report the use of extracorporeal membrane oxygenation as a means to support lung transplant recipients with severe graft failure. Since 1991, extracorporeal membrane oxygenation has been used on 17 occasions for the temporary support of 16 adult lung transplant recipients. All patients met or exceeded standard National Institutes of Health guidelines for institution of extracorporeal membrane oxygenation. Nine double lung, six single lung, and one heart-lung recipients were supported for 1 to 12 days (mean 4.6 +/- 2.2 days). Extracorporeal membrane oxygenation was instituted early, within 7 days of transplantation, in ten patients. Eight early patients (80%) were successfully weaned from extracorporeal membrane oxygenation. Seven of ten (70%) patients were long-term survivors, and five of the seven had normal lung function. In comparison, there were no survivors among six recipients placed on extracorporeal membrane oxygenation for late (> or = 7 days) graft dysfunction. Extracorporeal membrane oxygenation is a lifesaving adjunct in recipients with acute graft failure after lung transplantation. Ischemia-reperfusion injury and acute graft dysfunction after lung transplantation can be successfully reversed with early aggressive intervention.

Institutional experience with extracorporeal membrane oxygenation in lung transplantation☆

“…Soon its application for graft failure after lung transplantation became an accepted indication [6,7] and also its use as a bridge to transplant was reported [8]. Both indications became routine applications for the use of ECMO.…”

Early Institution of Extracorporeal Membrane Oxygenation for Primary Graft Dysfunction After Lung Transplantation Improves Outcome

“…Concerns raised by Glassman et al regarding bronchial anastomotic healing without bronchial artery perfusion may be counterbalanced with this approach. 18 The clinical advantages of the venovenous and venoarterial approaches for ECMO in this setting are summarized in Table 4. Peripheral cannulation is feasible in the ICU setting for PGD after lung transplantation.…”

Extracorporeal Membrane Oxygenation in Pulmonary Crisis and Primary Graft Dysfunction

“…11 When PGD remains unresponsive to maximal conventional management, ECMO can support gas exchange and stabilize the patient's condition until the lungs recover. [12][13][14][15][16] The V-V ECMO system has the theoretical advantage of perfusing most oxygenated blood directly to the right heart, providing optimal oxygen tension in the pulmonary circulation. By contrast, although V-A ECMO can provide support during both cardiac failure and respiratory failure, femoral V-A ECMO does not relieve severe hypoxemia in the upper body during severe oxygenation failure.…”