Lung Transplantation Using a Hybrid Extracorporeal Membrane Oxygenation Circuit

Abstract

Extracorporeal circulation (ECC) support using intraoperative extracorporeal membrane oxygenation (ECMO) during lung transplantation (LTx) is now a routine practice for many high volume centers. Circuits that are dedicated to ECMO alone can be expensive and do not allow full cardiopulmonary bypass (CPB) to be performed. We describe our technique of instituting venoarterial ECMO during LTx using a less-expensive hybrid circuit that facilitates easy and immediate conversion to full CPB if needed, without interruption of ECC.

Intraoperative management of a hybrid extracorporeal membrane oxygenation circuit for lung transplantation

“…We previously described a hybrid ECMO‐CPB circuit that provides lung transplantation teams the ability to provide ECC via either VA‐ECMO or CPB 2 . While the goals for intraoperative management of ECMO include maintenance of systemic perfusion and controlled reperfusion of the newly implanted lungs, achieving the balance between native and mechanical cardiac outputs can be challenging.…”

Intraoperative Management of a Hybrid Extracorporeal Membrane Oxygenation Circuit for Lung Transplantation

“…Ongoing assessment of preload within the system is vital to avoid ECMO suction events ("chattering in the lines"). 2 Due to the significant diversion of cardiac output to the hybrid ECMO circuit, the TEE is unable to accurately assess cardiac preload while on ECMO, yet remains useful as a direct monitor of cardiac contractility. We utilize ETCO 2 as a semi-quantitative/qualitative monitor of system preload based on the principle of ETCO 2 correlating with cardiac output.…”

“…We previously described a hybrid ECMO-CPB circuit that provides lung transplantation teams the ability to provide ECC via either VA-ECMO or CPB. 2 While the goals for intraoperative management of ECMO include maintenance of systemic perfusion and controlled reperfusion of the newly implanted lungs, achieving the balance between native and mechanical cardiac outputs can be challenging. Despite these challenges, successful implementation of VA-ECMO is important as it can provide theoretical attenuation of the ischemic-reperfusion injury and improved perioperative outcomes.…”

“…1 Intraoperative ECC for management of lung transplantation can be achieved with an extracorporeal membrane oxygenation (ECMO) circuit, cardiopulmonary bypass (CPB) circuit, or a hybrid ECMO-CPB circuit. 2 We previously described a novel design for an intraoperative hybrid ECMO circuit that is both cost-effective and facilitates conversion to CPB if necessary ( Figure 1). 2 Our novel technique for intraoperative management of the hybrid ECMO-CPB circuit, including considerations for monitoring and an organ-based management approach including cardiac, respiratory, and neurological systems is described.…”

“…2 We previously described a novel design for an intraoperative hybrid ECMO circuit that is both cost-effective and facilitates conversion to CPB if necessary ( Figure 1). 2 Our novel technique for intraoperative management of the hybrid ECMO-CPB circuit, including considerations for monitoring and an organ-based management approach including cardiac, respiratory, and neurological systems is described.…”