Extracorporeal Membrane Oxygenation in Lung Transplantation: Superior to Cardiopulmonary Bypass and Comparable to Off-Pump Strategy

Abstract

<h3>Purpose</h3> Extracorporeal membrane oxygenation (ECMO) may be used in combination with or in place of cardiopulmonary bypass (CPB) during lung transplantation (LTx). We hypothesize that in our center, intra-operative ECMO utilization yields superior outcomes to CPB alone. <h3>Methods</h3> Single-institution data for 742 LTx patients from February 2012 to March 2020 was collected based on intra-operative pump support; ECMO, CPB, "off-pump" and combined (CPB and ECMO). Patients with heart-lung transplant (HLT), concomitant procedures, and re-do LTx were excluded. Survival between groups (n=641) was evaluated with Kaplan-Meier curves and log-rank tests. Disparities in variables between groups were analyzed with ANOVA and Chi-squared tests. Significant variables were included in a Cox regression to determine potential impacts on survival corresponding to pump support. P values <0.05 were statistically significant. <h3>Results</h3> Cox regression displayed significant survival differences between ECMO (n=59), CPB (n=120), "off-pump" (n=458) and combined (n=4) groups (p=0.044). Compared to "off-pump", only CPB support (RR 1.52, 95%CI 1.11-2.10, p=0.01) had a significant negative survival impact. ANOVA and Chi-squared tests showed significant differences between groups in lung allocation score (p<0.0001), donor height (p=0.0045), length of stay (p<0.0001), patient age (p<0.0001), and patient BMI (p=0.018). Length of stay and diagnosis each significantly influenced survival (p<0.0001 and p=0.0046), but had no correlation to groups. Survival favored ECMO support at 1 and 2 years post-LTx, while off-pump was significantly beneficial at 4 and 5 years post-LTx (p=0.012). <h3>Conclusion</h3> Our center's results indicate comparable survival post-LTx with ECMO support as compared to off-pump technique. Independent CPB support displayed a significantly unfavorable survival outcome. This underscores the utility of ECMO support in future lung transplantation procedures.