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Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation
Open accessAbstract
Objectives The value of intraoperative extracorporeal membrane oxygenation (ECMO) in lung transplantation remains controversial. In our department, ECMO has been used routinely for intraoperatively unstable patients for more than 15 years. Recently, we have extended its indication to a preemptive application in almost all cases. In addition, we prolong ECMO into the early postoperative period whenever graft function does not meet certain quality criteria or in patients with primary pulmonary hypertension. The objective of this study was to review the results of this strategy.Methods All standard bilateral lung transplantations performed between January 2010 and June 2016 were included in this single-center, retrospective analysis. Patients were divided into 3 groups: group I-no ECMO (n = 116), group II-intraoperative ECMO (n = 343), and group III-intraoperative and prolonged postoperative ECMO (n = 123). The impact of different ECMO strategies on primary graft function, short-term outcomes, and patient survival were analyzed.Results The use of intraoperative ECMO was associated with improved 1-, 3-, and 5-year survival compared with non-ECMO patients (91% vs 82%, 85% vs 76%, and 80% vs 74%; log-rank P = .041). This effect was still evident after propensity score matching of both cohorts. Despite the high number of complex patients in group III, outcome was excellent with higher survival rates than in the non-ECMO group at all time points.Conclusions Intraoperative ECMO results in superior survival when compared with transplantation without any extracorporeal support. The concept of prophylactic postoperative ECMO prolongation is associated with excellent outcomes in recipients with pulmonary hypertension and in patients with questionable graft function at the end of implantation.
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“While VA ECMO offers hemodynamic stability and adequate gas exchange, and facilitates controlled allograft reperfusion,3,8,18,28 several reports have demonstrated higher rates of grade 3 PGD among patients who underwent BOLT with versus without ECMO support.9,10,13”
From Textbook outcome in lung transplantation: Planned venoarterial extracorporeal membrane oxygenation versus off-pump support for patients without pulmonary hypertension (2022) · cites this paper as [9]
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“In this context, our findings suggest that previously reported associations between planned VA ECMO and increased grade 3 PGD are likely confounded by differences in underlying physiology and illness severity between planned support strata.”
From Textbook outcome in lung transplantation: Planned venoarterial extracorporeal membrane oxygenation versus off-pump support for patients without pulmonary hypertension (2022) · cites this paper as [9]
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Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation
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Commentary: Close but not quite unequivocally unequivocal
Chan, E. G., & Hayanga, J. W. A. (2020) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2020.06.100
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Self-citationECMO Support in Lung Transplantation
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Commentary: The perfidious left ventricle in pulmonary hypertension
Wong, M. K.-H., & Hsin, M. K. Y. (2021) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2021.06.001
What Kind of Extracorporeal Support Should I Use During Lung Transplantation?
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Mulligan, M. S. (2019) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2019.09.122
Perioperative Management of Lung Transplant Recipients
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Extracorporeal Membrane Oxygenation (Adult)
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Surgical Advances in Lung Transplantation
Ali, A., Abdelnour‐Berchtold, E., & Cypel, M. (2021) · Elsevier eBooks · doi:10.1016/b978-0-08-102723-3.00261-4
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Abdominal Surgery Needs Extracorporeal Life Support as a Final Back-upPreprint
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Transplantation pulmonaire pour hypertension pulmonaire sévère
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Metadata
- Authors
- Hoetzenecker, K., Schwarz, S., Muckenhuber, M., Benazzo, A., Frommlet, F., Schweiger, T., Bata, O., Jaksch, P., Ahmadi, N., Muraközy, G., Prosch, H., Hager, H., Roth, G., Lang, G., Taghavi, S., & Klepetko, W.
- Affiliations
- Medical University of Vienna (AT)
- National Institute of Oncology (HU)
- University of Ottawa (CA)
- Corresponding author
- Klepetko, Walter
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 155
- Issue
- 5
- Pages
- 2193-2206.e3
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2772602769
- Cited by
- 242
- References
- 38
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 36 · 2023: 26 · 2022: 40 · 2021: 38 · 2020: 39 · 2019: 23 · 2018: 9
- FWCI
- 19.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- extracorporeal membrane oxygenation, intraoperative ECMO, bilateral lung transplantation, primary graft function, patient survival, idiopathic pulmonary arterial hypertension, graft function
- MeSH terms
- Adult, Female, Graft Survival, Humans, Hypertension, Pulmonary, Intraoperative Care, Lung Diseases, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, Extracorporeal Membrane Oxygenation, Lung Transplantation, Treatment Outcome, Risk Assessment, Primary Graft Dysfunction
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