The wythenshawe hybrid circuit: a novel technique for lung transplantation

Abstract

Introduction Wythenshawe Hospital is one of only six heart transplant units in the UK and one of five to perform lung transplant. Every year, around 60 transplant operations are performed, and in 2018, 32 lung transplants were carried out, with a 90 day survival rate of 91.7% as per the UK Organ Donation and Transplantation Activity Report 2017/18. Methods When the transplant program was initiated, lungs were initially done using Cardiopulmonary Bypass Support. In the past few years, ECMO has taken over and it is now the preferred method of support. Because lung transplants are surgically challenging operations, occasionally, conversion from ECMO to Cardiopulmonary Bypass during the procedure is needed. Taking this into account, we have designed an Extracorporeal Circulation system that allows quick and easy switching from ECMO to Cardiopulmonary Bypass shall a complication arises (Figure 1). Results Since 2018, we have done 29 lung transplants using our Hybrid Circuit, with no difference in patient outcome compared to lungs done using standard ECMO circuitry. However, the utilization of this circuit offers many user-related advantages versus the usage of standard ECMO. Some of this include easier volume and drug additions, inclusion of volatile agents in the gas mixture, possibility of recording the case using a data management system and a straightforward switch to Cardiopulmonary Bypass if required. Discussion Even if the Hybrid Circuit set up is slightly more complex than setting up an ECMO or a Cardiopulmonary Bypass circuit, we believe that this technique is superior to the previous methods used for lung transplantation. If offers all the benefits of ECMO versus Cardiopulmonary Bypass, such as less Heparin usage and lower priming volumes, plus, it is a more interactive and user-friendly system designed to deal with emergencies in an efficient manner.