Predictors of using extracorporeal membrane oxygenation in lung transplantation

Rationale. Lung transplantation is the only definitive treatment in end-stage pulmonary disease. Extracorporeal membrane oxygenation (ECMO) has been used during surgery in recent years as a replacement for respiratory function; ECMO, however, has some drawbacks: the presence of an extracorporeal circuit, the need for heparinization, potential thrombogenicity that underlies the risks of developing specific complications that worsen the transplantation prognosis. In this regard, it is relevant to study the factors that make it possible to predict the need in intraoperative ECMO in order to avoid its unjustified use.

Purpose. To identify predictors for intraoperative use of ECMO in lung transplantation.

Material and methods. The medical records of patients who underwent lung transplantation in the Sklifosovsky Research Institute for Emergency Medicine from May 2011 to July 2017 were retrospectively reviewed. Forty nine bilateral lung transplantations were made where 15 patients (30.6%) had lung transplantation performed without ECMO, and 34 (69.4%) underwent lung transplantation and ECMO. A central veno-arterial connection was used in all patients. The study analyzed various factors of patient condition at baseline and identified the most significant of them that enabled to predict the need of ECMO use at surgery with a high degree of probability, avoiding episodes of gas exchange and hemodynamic impairments, the prolongation of surgery, and, therefore, the graft ischemia time.

Results. As assessed in this study, pulmonary hypertension was the only predictor of an increased likelihood of using ECMO. The probability of connection to ECMO statistically significantly increased in the patients with systolic pulmonary artery pressure higher 50 mm Hg (p<0.05).

Conclusion. The presence of pulmonary hypertension > 50 mm Hg determines the preventive use of ECMO during lung transplantation, which should reduce the number of uncontrolled emergencies during the main stages of surgical intervention; in all other cases, ECMO should be connected basing either on the pulmonary artery compression test results or when indicated. 

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