Less Delayed Chest Closure, Systemic Edema, and Postoperative Bleeding in Lung Transplantation Using ECMO, Compared with CPB

Abstract

Purpose Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) may be used as extracorporeal circulation (ECC) during lung transplantation. We aimed to compare CPB and ECMO in terms of short-term outcomes in lung transplantation (LTx). Methods Among 185 patients undergoing LTx including 81 living-donor-related LTx from 2008 to June, 2018 in our institution, CPB was used in 41 patients and ECMO in 89 patients. Since 2013, we have routinely used ECMO, while CPB has been selectively used in pediatric and complicated cases requiring PA replacement or ASD closure. We retrospectively evaluated perioperative factors and short-term outcomes including delayed chest closure (DCC), in comparison of CPB group and ECMO group. DCC is required due to primary graft dysfunction manifesting as hypoxia, pulmonary hypertension, and lung edema. Assuming that CPB causes systemic inflammation leading to systemic edema, we also investigated perioperative increase ratio of body weight. Results Gender, surgical procedure (single or bilateral), and donor (cadaveric or living) and indications were not significantly different between the two groups, while patients in ECMO group were significantly older (40 vs 32 years, p=0.038), and weighed more (47 vs 38 kg, p=0.001). Thirty-day mortality was similar (1.1% in ECMO group; 2.4% in CPB group). The operation time, ECC time, and the amount of blood loss were not significantly different, while ECMO group was associated with significantly less transfusion intraoperatively (4339 ml in ECMO group; 6753 ml in CPB group, p=0.002). Reoperations for bleeding were less frequently required in ECMO group than in CPB group (7% vs 29%, p=0.003). DCC was less frequently required in ECMO group than in CPB group (9% vs 29%, p=0.013). The increase of body weight measured at the time of ICU admission was significantly remarkable in CPB group than in ECMO group (increased by 9.7% vs by 4.7%, p=0.006). Conclusion LTx using ECMO was associated with less intraoperative transfusion, and less postoperative re-exploration to CPB. ECMO was associated with less frequent delayed chest closure, possibly related to less systemic edema.