Intraoperative Extracorporeal Membrane Oxygenation as an Alternative to Cardiopulmonary Bypass in Lung Transplantation

Abstract

Purpose Extracorporeal membrane oxygenation (ECMO) may be used for intraoperative support as an alternative to cardiopulmonary bypass (CPB) during lung transplantation. We sought to evaluate its efficacy. Methods and Materials We reviewed lung transplants with intraoperative support (CPB or ECMO) from 8/09-11/12. Patients were stratified into groups by type of support. Postoperative ECMO utilization, graft and overall survival were compared along with blood product utilization and complications. For comparisons, a 2:1 propensity matched cohort of CPB:ECMO was analyzed. Results 169 patients underwent lung transplantation with mechanical support during the study period (17 ECMO and 152 CPB). Demographic were similar in both groups with higher mean Lung Allocation Score (LAS; 83 vs 56) in the ECMO group. Patients transplanted on ECMO in the overall groups were extubated earlier (0.8 vs 4.8 days; p=0.11) and had significantly decreased rates of respiratory failure post transplantation (29% vs 6%; p=0.04) with similar trends in the propensity matched cohort. There were no differences in postoperative ECMO utilization between groups. A trend toward improved overall survival was seen with ECMO at 1 year (100% vs 77%) and 3 years (100% vs 66%; p=0.13). Graft survival was significantly improved in the ECMO group (p=0.05). [ figure 1 ] Conclusions Intraoperative ECMO support for primary lung transplantation is comparable to CPB and is associated with earlier extubation, significant reduction in respiratory complications, a trend toward lower transfusion requirement and improved overall survival. Graft survival was significantly improved with the use of ECMO. Further longitudinal data is necessary.