Replacing cardiopulmonary bypass with extracorporeal membrane oxygenation in lung transplantation operations☆

Abstract

The advantages of femoral canulation rather than conventional central connections in lung transplantation procedures led to an undisturbed operative field. A significantly higher blood product amount was required in ECMO patients, which might lead to increased infection and mortality rates. CPB, obviously, should remain the standard support technique if extracorporeal circulation is required in lung transplantation surgery.

Comparison of extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation

“…Preliminary data regarding the utility of ECMO relative to CPB is varied. A study by Bittner and colleagues 16 in 2006 suggested that ECMO use led to higher rates of blood product transfusions, as well as worse 1-year survivals. 16 A more recent report from Ius and coworkers 15 in 2012 demonstrated lower blood product transfusion rates and improved survivals at 3, 9, and 12 months in the ECMO group relative to the CPB group.…”

“…A study by Bittner and colleagues 16 in 2006 suggested that ECMO use led to higher rates of blood product transfusions, as well as worse 1-year survivals. 16 A more recent report from Ius and coworkers 15 in 2012 demonstrated lower blood product transfusion rates and improved survivals at 3, 9, and 12 months in the ECMO group relative to the CPB group. 15 With a recent paradigm shift at our institution from intraoperative CPB to ECMO, we sought to compare intraoperative and postoperative outcomes between the 2 groups.…”

“…13,14 Because of the potential pulmonary complications of CPB and the widespread use of ECMO, several lung transplant centers have begun to use intraoperative ECMO instead of CPB, with mixed results. [15][16][17] ECMO has potential advantages in that there is no venous reservoir or cardiotomy suction, leading to lessened blood-air interface, and it also allows an easy transition to postoperative ECMO for cardiopulmonary support if necessary. Beginning in 2011, our transplant center began incorporating ECMO intraoperatively in lieu of CPB when feasible.…”

Established and potential predictors of blood loss during lung transplant surgery

“…The impact of ECMO on blood loss needs to be established. There are studies that suggest ECMO might provide a better view in the operation field for the surgeon, and therefore contribute to less transfusions (29,30), however, there are also contradictory studies that held ECMO to be responsible for blood loss and blood transfusion requirements (31), while other studies do not show any difference between CPB and ECMO (32). Hence, the role of extracorporeal circulation support in blood loss in lung transplantations is not yet completely understood.…”

Transition to routine use of venoarterial extracorporeal oxygenation during lung transplantation could improve early outcomes

“…However, they use ECMO on a selective basis and more than 50% of patients were performed LTx without cardiopulmonary support with excellent outcomes (17,18). However, our institute has limited experience and lower annual volume.…”