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

Hashimoto, Kohei; Höetzenecker, Konrad; Yeung, Jonathan C.; Jeagal, Luke; Donahoe, Laura; Pierre, Andrew; Perrot, Marc de; Waddell, Thomas K.; Keshavjee, Shaf; Cypel, Marcelo

doi:10.1016/j.healun.2018.07.003

Cited by 48 publications

(41 citation statements)

References 24 publications

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“…As reported by other studies, the use of therapeutic ECMO to treat an already present PGD grade 3 has very poor results which are confirmed in our experience (in‐hospital mortality for pECMO 13.3% vs. 42% in therapeutic ECMO). As already demonstrated by other recent published series, the incidence of postoperative or intraoperative complications related with the use of ECMO are minimal. The new ECMO devices, the heparin coated circuits, the new hollow fiber oxygenator etc, are effective in reducing device‐related complications .…”

Section: Discussionsupporting

confidence: 63%

“…They demonstrated that the use of prophylactic venoarterial ECMO in the postoperative period reduces in‐hospital mortality and favors achievement of normal cardiac function after 1 year . In light of this evidence, CPB has been replaced with ECMO as a standard intraoperative ECLS and eventually post operatively in many of the higher volume centers worldwide …”

Section: Discussionmentioning

confidence: 99%

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Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension

et al. 2020

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The use of extracorporeal membrane oxygenator instead of standard cardiopulmonary bypass during lung transplantation is debatable. Moreover, recently, the concept of prolonged postoperative extracorporeal membrane oxygenator (ECMO) support has been introduced in many transplant centers to prevent primary graft dysfunction (PGD) and improve early and long-term results.The objective of this study was to review the results of our extracorporeal life support strategy during and after bilateral sequential lung transplantation (BSLT) for pulmonary artery hypertension. We review retrospectively our experience in BSLT A total of 38 patients were identified. Nine patients were transplanted using cardiopulmonary bypass (CPB), in eight cases CPB was followed by a prolonged ECMO (pECMO) support, 14 patients were transplanted on central ECMO support, and seven patients were transplanted with central ECMO support followed by a pECMO assistance. The effects of different support strategies were evaluated, in particular in-hospital morbidity, mortality, incidence of PGD, and long-term follow-up. The use of CPB was associated with poor postoperative results and worse long-term survival compared with ECMO-supported patients. Predictive preoperative factors for the need of intraoperative CPB instead of ECMO were identified. The pECMO strategy had a favorable effect to mitigate postoperative morbidity and mortality, not only in intraoperative ECMO-supported patients, but even in CPB-supported cases. In our experience, ECMO may be considered as the first choice circulatory support for lung transplantation. Sometimes, in very complex cases, CBP is still necessary. The pECMO strategy is very effective to reduce incidence of PGD even in CPB-supported patients. K E Y W O R D S cardiopulmonary bypass, extracorporeal membrane oxygenation, extracorporeal support technique, lung transplantation, pulmonary hypertension 630 | DELL'AMORE Et AL. F I G U R E 1 Examples of clear indication for CPB instead of ECMO. A, extreme cardiomegaly. B, severe dilatation of the right and left pulmonary artery branches. C, severe aneurysm of the main pulmonary artery. D, over-systemic pulmonary artery hypertension (pulmonary artery pressure shown in yellow and systemic pressure shown in red) [Color figure can be viewed at wiley onlin elibr ary.com] F I G U R E 2 ECLS techniques. A, aorto-bicaval CPB cannulation. B, aorto-bicaval CPB cannulation with pulmonary artery vent (black arrow). C, central aorto-right atrium ECMO cannulation. D, prolonged ECMO setting with peripheral femoro-femoral cannulation with distal leg perfusion [Color figure can be viewed at wiley onlin elibr ary.com] How to cite this article: Dell'Amore A, Campisi A, Congiu S, et al. Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension

et al. 2020

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“…While VV ECMO is typically the preferred configuration as a bridge to transplant and has been studied in high-risk pulmonary resections, to date there are minimal studies evaluating VV ECMO for intraoperative lung transplantation. 46 Hashimoto et al 47 recently analyzed patients bridged with VV ECMO and intraoperatively 59% of patients remained on VV ECMO, whereas 32% were transitioned to VA ECMO due to hemodynamic instability. 22 The remainder were transitioned to CPB.…”

Section: Intraoperative Ecmo Supportmentioning

confidence: 99%

“…However, VA ECMO was associated with higher intraoperative transfusions and was noted to be more frequently performed for lobar transplantation. 47 In order to reduce complications associated with ECMO, planned intraoperative ECMO use is occasionally reserved for high-risk patients who might otherwise require CPB. These patients include those requiring preoperative ECMO as a bridge to transplantation, those with planned concomitant cardiac procedures or planned lobar lung transplant to protect the small lung size from hyperperfusion, and those with etiologies of pulmonary artery hypertension as the indication for transplant including idiopathic, sarcoidosis, and chronic thromboembolic disease.…”

Section: Intraoperative Ecmo Supportmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in the Perioperative Care of the Lung Transplant Patient

Hayanga

Chan

Musgrove

et al. 2020

Semin Cardiothorac Vasc Anesth

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Lung transplantation (LT) is definitive therapy for end-stage lung disease. Donor allocation based on medical urgency has led to an increased trend in the transplantation of sicker and older patients. Mechanical ventilation (MV) formerly was the only method of bridging high-acuity patients to LT. When the physiological demands of ventilatory support exceeds the capability of MV, extracorporeal membrane oxygenation (ECMO) may become necessary. Recent improvements in ECMO technology and component design have led to a resurgence of interest in its use before, during, and after LT. Survival with ECMO as a bridge to LT has improved over time, now with many centers reporting little or no difference in outcomes, and some even reporting better outcomes, as compared with MV. Extracorporeal life support may also be used intraoperatively. In many studies to date, ECMO or cardiopulmonary bypass (CPB) has been reserved for patients who became hemodynamically unstable during the procedure or patients who could not tolerate single-lung ventilation. Both methods of support are fraught with potential complications. However, multiple studies comparing ECMO with CPB have shown that intraoperative use of ECMO resulted in improved outcomes and overall survival as well as lower rates of bleeding complications. In order to further reduce complications associated with ECMO, planned intraoperative ECMO use is occasionally reserved for high-risk patients who might otherwise require CPB. Future studies will need to improve patient selection to fully take advantage of the use of ECMO in LT while minimizing its costs.

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“…In the field of organ transplantation, ECMO can be used to facilitate liver transplant and in cases of right heart dysfunction after heart transplant 3,4 . It can also be utilized during lung transplant to maintain adequate oxygenation while the implantation procedure is performed 5,6 . Additionally, intraoperative ECMO has been demonstrated to effectively support patients with airway blockage and during airway reconstruction 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Postoperative extracorporeal membrane oxygenation can successfully support patients following upper airway reconstruction

et al. 2020

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Background: Patients requiring intensive upper airway reconstruction are anatomically restricted in terms of the respiratory support they can receive. While intraoperative extracorporeal membrane oxygenation (ECMO) has been effectively utilized, little has been shown regarding the utility of ECMO for long-term support in these patients. Methods: We demonstrate how a patient with tongue and hypopharyngeal squamous cell carcinoma that necessitated upper airway reconstruction was supported with veno-venous (VV) ECMO due to postoperative respiratory failure and an inability to maintain a stable airway. Results: By initiating VV ECMO, we were able to decrease positive pressure ventilation and FiO 2 , thereby minimizing ventilator-associated trauma and irritation to facilitate wound healing. Over time, ventilatory support was increased in parallel with decreasing ECMO support, allowing discharge to rehabilitation after 74 days of ECMO. Conclusion: ECMO can effectively support patients with ongoing respiratory requirements following upper airway reconstruction when standard ventilatory techniques are inadequate or not feasible.

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

Cited by 48 publications

References 24 publications

Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension

Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension

Extracorporeal Membrane Oxygenation in the Perioperative Care of the Lung Transplant Patient

Postoperative extracorporeal membrane oxygenation can successfully support patients following upper airway reconstruction

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