Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 27;16(1):341.
doi: 10.1186/s13019-021-01719-0.

Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation

Nikola Ruszel  1 , Kajetan Kiełbowski  2 , Maria Piotrowska  2 , Michał Kubisa  2 , Tomasz Grodzki  2 , Janusz Wójcik  2 , Bartosz Kubisa  2
Affiliations

Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation

Nikola Ruszel et al. J Cardiothorac Surg. .

Abstract

Background: Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications.

Methods: We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan-Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables.

Results: The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups.

Conclusions: The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable.

Keywords: CPB; ECC; ECMO; Lung transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Scheme 1
Scheme 1
Visual presentation of the analyzed group of patients
Scheme 2
Scheme 2
Cannulation of: a central ECMO, CPB, b peripheral ECMO. a Vena cava inferior (through right atrium)- pump- oxygenator- ascending aorta. b Femoral vein- pump-oxygenator-femoral artery
Fig. 1
Fig. 1
Kaplan–Meier curves. a Off pump, b CPB, c peripheral ECMO, d central ECMO
See this image and copyright information in PMC

References

    1. Weill D. Lung transplantation: indications and contraindications. J Thorac Dis. 2018;10(7):4574–4587. doi: 10.21037/jtd.2018.06.141. - DOI - PMC - PubMed
    1. Whitson B, Hayes D., Jr Indications and outcomes in adult lung transplantation. J Thorac Dis. 2014;6(8):1018–1023. - PMC - PubMed
    1. Lansink-Hartgring A, van der Bij W, Verschuuren E, et al. Extracorporeal life support as a bridge to lung transplantation: a single-center experience with an emphasis on health-related quality of life. Resp Care. 2017;62(5):588–594. doi: 10.4187/respcare.05300. - DOI - PubMed
    1. Hayanga J, Lira A, Vlahu T, et al. Lung transplantation in patients with high lung allocation scores in the US: evidence for the need to evaluate score specific outcomes. J Transplant. 2015;2015:836751. doi: 10.1155/2015/836751. - DOI - PMC - PubMed
    1. Horai T, Shigemura N, Gries C, et al. Lung transplantation for patients with high lung allocation score: single-center experience. Ann Thorac Surg. 2012;93(5):1592–1597. doi: 10.1016/j.athoracsur.2011.09.045. - DOI - PubMed