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1.
J Cardiothorac Vasc Anesth ; 33(7): 1995-2006, 2019 Jul.
Article in English | MEDLINE | ID: mdl-30455142

ABSTRACT

Lung transplantation has become an accepted therapy for most causes of end-stage lung disease. Between 30 to 50% of lung transplants require extracorporeal life support (ECLS). In many lung transplantation centers, extracorporeal membrane oxygenation (ECMO) is replacing cardiopulmonary bypass (CPB) as the primary choice for intraoperative ECLS. This review will discuss the evolving role of ECMO in lung transplantation and its implications for anesthetic management.


Subject(s)
Anesthesia/methods , Anesthetics/pharmacology , Extracorporeal Membrane Oxygenation/methods , Lung Transplantation/methods , Respiratory Insufficiency/surgery , Humans
2.
J Thorac Cardiovasc Surg ; 149(4): 1152-7, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25583107

ABSTRACT

OBJECTIVE: The study objective was to compare the outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass support in lung transplantation. METHODS: We performed a retrospective cohort study from a prospective database of adult lung transplantations performed at the University of Toronto from 2007 to 2013. Among 673 lung transplantations performed in the study period, 267 (39.7%) required cardiopulmonary support. There were 39 cases of extracorporeal membrane oxygenation (2012-2013) and 228 cases of cardiopulmonary bypass (2007-2013). Patients who were bridged with extracorporeal life support, underwent a concomitant cardiac procedure, received a combined liver or heart transplant, were colonized with Burkholderia cenocepacia, or required emergency cannulation for cardiopulmonary support were excluded. Finally, 33 extracorporeal membrane oxygenation cases were matched with 66 cases of cardiopulmonary bypass according to age (±10 years), lung transplantation indication, and procedure type (bilateral vs single lung transplantation). RESULTS: Recipient factors such as body mass index and gender were not different between extracorporeal membrane oxygenation and cardiopulmonary bypass groups. Furthermore, donor variables were similar, including age, body mass index, last PaO2/FiO2 ratio, smoking history, positive airway cultures, and donor type (brain death and donation after cardiac death). Early outcomes, such as mechanical ventilation requirement, length of intensive care unit stay, and length of hospital stay, significantly favored extracorporeal membrane oxygenation (median 3 vs 7.5 days, P = .005; 5 vs 9.5 days, P = .026; 19 vs 27 days, P = .029, respectively). Perioperative blood product transfusion requirement was lower in the extracorporeal membrane oxygenation group. The 90-day mortality for the extracorporeal membrane oxygenation group was 6% versus 15% for cardiopulmonary bypass (P = .32). CONCLUSIONS: Extracorporeal membrane oxygenation may be considered as the first choice of intraoperative cardiorespiratory support for lung transplantation.


Subject(s)
Cardiopulmonary Bypass , Extracorporeal Membrane Oxygenation , Idiopathic Pulmonary Fibrosis/surgery , Lung Transplantation/methods , Pulmonary Disease, Chronic Obstructive/surgery , Adult , Aged , Cardiopulmonary Bypass/adverse effects , Cardiopulmonary Bypass/mortality , Databases, Factual , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/mortality , Female , Humans , Idiopathic Pulmonary Fibrosis/diagnosis , Idiopathic Pulmonary Fibrosis/mortality , Intensive Care Units , Kaplan-Meier Estimate , Length of Stay , Lung Transplantation/adverse effects , Lung Transplantation/mortality , Male , Middle Aged , Ontario , Postoperative Complications/mortality , Postoperative Complications/therapy , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/mortality , Respiration, Artificial , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
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