Perioperative Use of ECMO During Double Lung Transplantation

Abstract

Lung transplantation has become an established option in end-stage lung disease therapy. Some sequential double-lung transplantations require cardiopulmonary bypass (CPB) support during surgical procedure. However, conventional CPB increases the risks of bleeding and early allograft dysfunction. This report summarizes the perfusion techniques for replacing conventional CPB with extracorporeal membrane oxygenation (ECMO) during sequential double-lung transplantation procedure in our hospital. Between November 2002 and December 2006, nine cases of sequential double-lung transplantation were set up for ECMO during the surgical procedure. All patients suffered from end-stage lung disease. Eight patients were prepared for the procedure via transverse thoracostomy (clamshell) and cannulated through the ascending aorta and right atrium for ECMO before implantation of the second lung. The first patient who underwent bilateral thoracotomy for bilateral sequential lung transplantation required emergency ECMO via the femoral artery and vein during the second lung implantation. The Medtronic centrifugal pump and ECMO package were used for all of the cases. During ECMO, the blood flow was set at 1.8-2.0 L/m2/min; colloid oncotic pressure was maintained at more than 18 mm Hg, with albumin and hematocrit kept at 28% or more. There were two cases of early death in the group; the other cases were weaned from ECMO successfully. Extracorporeal membrane oxygenation duration was 1.83-67 hours, and postoperative intubation was 18-67 hours. As a successful technique of heart-lung support, ECMO can supply hemodynamic stabilization, reducing factors such as ischemia-reperfusion injury, anticoagulation requirement, and systemic inflammatory response for sequential double-lung transplantation.

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

“…[7][8][9] After some initial experimental reports, these favorable characteristics prompted the application of ECMO as an intraoperative support in a larger series of lung transplant recipients. 10,11 In addition, successful applications of ECMO as a bridge to transplantation in patients with preoperative refractory respiratory failure [12][13][14] and as a bridge to recovery in patients with primary graft dysfunction 15 have been published.…”

Respiratory failure after lung transplantation: extracorporeal membrane oxygenation as a rescue treatment

“…In conjunction with lung transplantation, ECMO may be useful as a temporary support for respiratory failure while patients are waiting for the organ and after transplantation in cases of refractory hypoxemia (23-25). Most cases of severe hypoxemia after LTx are due to PGD and result in high rates of mortality.…”

Risk Factor Analysis for Intraoperative Extracorporeal Membrane Oxygenation Weaning Failure After Lung Transplantation

“…As a result of these promising findings, many centers have adopted ECMO as the standard method for extracorporeal support [10][11][12]. Indeed, at our institution, we have routinely used ECMO on all patients who have undergone LTx since March 2013.…”

“…Compared with cardiopulmonary bypass (CPB), ECMO is advantageous as a result of its simple setup, lesser priming volume, lack of blood-air interfaces, lower coagulopathy, and decreased systemic inflammatory response [7][8][9]. These benefits have spurred several facilities to adopt ECMO as the standard method of support for patients undergoing LTx [10][11][12].…”